Angiotensin converting enzyme inhibitors and risk of lung cancer: a population-based cohort study

ObjectivesTo determine whether the use of angiotensin converting enzyme inhibitors (ACEIs) was associated with a higher risk of lung cancer when compared to use of angiotensin receptor blockers (ARBs). Study DesignPopulation-based cohort study. SettingPublic hospitals under the Hospital Authority in Hong Kong, P.R. China. MethodsPatients admitted to public hospitals and first prescribed with ACEI and/or ARB between 1 January 2001 and 31 December 2018 were analyzed. The last follow-up date was 31 August 2020, or death, whichever was earlier. OutcomesThe primary outcome was the incidence of lung cancer. Logistic regression was used to calculate odds ratio [ORs] with 95% confidence intervals associated with the use of ACEIs compared to ARBs. Incidence and odds ratios were estimated for temporal analysis of incident cancer risk associated with time since the first prescription of ACEI or ARB. ResultsIn the unmatched cohort, 56,697 patients and 357,011 patients were included the ARB and ACEI cohorts, with lung cancer incidence of 2.16% and 1.29%, respectively. Using 1:3 matching for ARB to ACEI users, the incidences were 2.32% and 1.29%. ACEI use was associated with increased risks of lung cancer both before (hazard ratio: 1.30 [1.21-1.40], P<0.0001) and after (1.40 [1.29-1.51], P<0.0001) matching. There was a dose-dependent relationship between ACEI exposure and lung cancer risk. ConclusionsACEI use was associated with increased risk of lung cancer compared with ARB use at all time points. Additionally, incidence risk increases with the duration of exposure.