Key result
Angiotensin II receptor blocker therapy did not increase overall cancer incidence compared to controls across 15 trials involving 138,769 patients (OR 1.00, 95% CI 0.95-1.04).
Why the study?
Does ARB therapy increase the risk of incident cancers in individuals at high CVD risk?
Does ARB therapy increase the risk of incident cancers in individuals at high CVD risk?
This large meta-analysis demonstrates that ARB therapy does not increase the risk of incident cancers or cancer-related deaths in patients at high cardiovascular risk.
ARBs remain appropriate for high-CVD-risk patients; confirms no cancer risk elevation in RCT meta-analysis.
BACKGROUND: Angiotensin-converting enzyme inhibitors (ACEi) and angiotensin II receptor blockers (ARBs) reduce cardiovascular disease (CVD) events, but a recent meta-analysis of selected studies suggested that ARBs may increase cancer risks. OBJECTIVE: Candesartan, irbesartan, telmisartan, valsartan, and losartan were assessed for incident cancers in 15 large parallel long-term multicenter double-blind clinical trials of these agents involving 138,769 participants. PATIENTS AND METHODS: Individuals at high CVD risk were randomized to telmisartan (three trials, n=51,878), irbesartan (three trials, n=14,859), valsartan (four trials, n=44,264), candesartan (four trials, n=18,566), and losartan (one trial, n=9193) and followed for 23-60 months. Incident cancer cases were compared in patients randomized to ARBs versus controls. In five trials (n=42,403), the ARBs were compared to ACEi and in 11 trials (n=63,313) to controls without ACEi. In addition, in seven trials (n=47,020), the effect of ARBs with ACEi was compared to ACEi alone and in two trials ARBs with ACEi versus ARB alone (n=25,712). RESULTS: Overall, there was no excess of cancer incidence with ARB therapy compared to controls in the 15 trials [4549 (6.16%) cases of 73,808 allocated to ARB versus 3856 (6.31%) of 61 106 assigned to non-ARB controls; odds ratio (OR) 1.00, 95% confidence interval (CI) 0.95-1.04] overall or when individual ARBs were examined. ORs comparing combination therapy with ARB along with ACEi versus ACEi was 1.01 (95% CI 0.94-1.10), combination versus ARB alone 1.02 (95% CI 0.91-1.13), ARB alone versus ACEi alone 1.06 (95% CI 0.97-1.16) and ARB versus placebo/control without ACEi 0.97 (95% CI 0.91-1.04). There was no excess of lung, prostate or breast cancer, or overall cancer deaths associated with ARB treatment. CONCLUSION: There was no significant increase in the overall or site-specific cancer risk from ARBs compared to controls.
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The ARB Trialists Collaboration (2011) studied this question. Angiotensin II receptor blocker therapy did not increase overall cancer incidence compared to controls across 15 trials involving 138,769 patients (OR 1.00, 95% CI 0.95-1.04).
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