Incidence of pancreatic cancer in angiotensin-converting enzyme inhibitors (ACEIs) versus angiotensin receptor blockers (ARBs): a population-based cohort study

BackgroundAngiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) have been associated with lower rates of pancreatic cancer. However, some studies did not similarly reveal significant associations. The objective of this study was to examine the associations between use of ACEIs or ARBs and incident pancreatic cancer. MethodsPatients who were prescribed ACEI or ARB between 1 January 2000 and 31 August 2020 at Hong Kong public hospitals, or their associated clinics and ambulatory care facilities were included. The primary outcome was incident pancreatic cancer. ResultsA total of 411,883 patients (ACEI users: n=355771, 86.38%; ARB users: 56112, 13.62%) were included. Over a median follow up of 2875 days (SD: 1901), 1194 incident cases of pancreatic cancer (0.28%) were identified. After 1:1 propensity score matching, univariable Cox regression found that ARB use was associated with lower risks of new onset new onset pancreatic cancer (hazard ratio [HR]: 0.69, 95% CI: [0.53, 0.90], P=0.0065). This association remained significant after multivariable adjustment (HR: 0.67, 95% CI: [0.52, 0.88], P=0.0036). Similar conclusions were reached on competing risk analyses using cause-specific and subdistribution hazard models before and after matching, and after inverse probability of treatment weighting. Subgroud analyses identified higher protective effects of ARB exposures in females than in males, while more severe adverse risks of ACEI exposure effects for males than for females (log-rank test, P<0.05). ConclusionsARB use was associated with lower risks of new onset pancreatic cancer both before and after propensity score matching compared to ACEI use.