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Do renin-angiotensin system inhibitors reduce risk for hepatocellular carcinoma?: A nationwide nested case-control

Kwang Min Kim1, Ji Hye Roh2, Sangjin Lee3

  • 1Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea.

Clinics and Research in Hepatology and Gastroenterology
|December 4, 2020
PubMed
Abstract

Insights

Renin-angiotensin system inhibitors (RASi) showed no overall association with liver cancer (HCC) prevention. However, specific subgroups, particularly women and those with higher cumulative doses, experienced a reduced risk of HCC development.

Area of Science:

  • Oncology
  • Pharmacology
  • Cardiovascular Medicine

Background:

  • Growing interest in renin-angiotensin system inhibitors (RASi) for hepatocellular carcinoma (HCC) prevention due to potential anti-angiogenic effects.
  • Previous research suggests a possible role for RASi in mitigating HCC development.

Purpose of the Study:

  • To investigate the association between the use of renin-angiotensin system inhibitors (RASi) and the incidence of hepatocellular carcinoma (HCC).

Main Methods:

  • A nested case-control study design involving 567 HCC cases and matched controls.
  • Propensity score matching (1:1) was utilized to ensure comparability between cases and controls.
  • RASi exposure was assessed based on ever-user/never-user status, cumulative dose, and prescription duration, with adjusted odds ratios (aORs) calculated.

Main Results:

  • No significant overall association was observed between RASi use and HCC incidence (aOR, 0.77; 95% CI, 0.56-1.07).
  • Subgroup analyses revealed a significant reduction in HCC risk for women receiving RASi (aOR, 0.49; 95% CI, 0.24-0.95) and with Angiotensin II Receptor Blocker (ARB)-only use (aOR, 0.65; 95% CI, 0.43-0.97) at higher cumulative doses (≥30 cDDDs).
  • A notable decrease in HCC risk was observed in non-diabetic subjects with very high cumulative RASi doses (≥1800 cDDD) (aOR, 0.26; 95% CI, 0.08-0.72).

Conclusions:

  • The study did not confirm a significant overall protective effect of RASi against HCC.
  • A potential benefit of RASi in reducing HCC incidence was suggested in specific patient subgroups, particularly at higher cumulative doses.
  • Further investigation into the dose-dependent effects and specific patient populations may be warranted.
Keywords:
Angiotensin II receptor blockersDefined daily dosesHepatocellular carcinomaNested case-control studyRenin-angiotensin system inhibitors

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