Approximately 31.5% of men and 29.0% of women in the UK have high blood pressure (hypertension). Angiotensin converting enzyme inhibitors (ACEIs), along with angiotensin receptor blockers, are commonly used therapies to treat hypertension and are widely used within the UK. While ACEIs have been demonstrated to be relatively safe medications, in recent years, the potential effects of ACEIs on lung cancer has been subject to debate. Few studies have investigated this potential harmful effect, and these studies have found mixed results, with some studies finding increases in lung cancer risk while others reporting no difference. Given these discrepancies, new well conducted studies are needed to assess if this risk is substantiated. This study will investigate whether the use of ACEIs increases the risk of lung cancer in the Clinical Practice Research Datalink. This study will provide much needed information of this potential adverse drug effect, which will be of value to regulatory agencies, physicians, and patients.
Angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), are antihypertensive medications that act upon the renin angiotensin system to reduce blood pressure. While ACEIs have been shown to be relatively safe, recently the potential effects of ACEIs on lung cancer incidence has been subject to debate. Preclinical studies suggest that ACEIs may increase lung cancer incidence via the accumulation of bradykinin in the lung. However observational studies are limited and observed inconsistent results. Thus, the objective of this study will be to assess this association by assembling a study cohort of patients who initiated an antihypertensive medication on or after January 1 1995 until September 30, 2015. All patients will be followed until a first-ever diagnosis of lung cancer, or censored upon death, end of registration with the practice, or end of the study period (September 30, 2016). Time-dependent Cox proportional hazard models will be used to estimate hazard ratios and 95% confidence intervals of lung cancer associated with the use ACEIs when compared with the use of ARBs, with exposures lagged by 1 year for latency purposes. Secondary analyses will assess whether the risk varies according to cumulative duration of use and time since initiation.
The outcome of interest is a primary diagnosis of lung cancer, determined from GP recorded diagnostic/symptom codes, until the 30th September 2016 (end of study period).
Samy Suissa - Chief Investigator - Sir Mortimer B Davis Jewish General Hospital
Samy Suissa - Corresponding Applicant - Sir Mortimer B Davis Jewish General Hospital
Blánaid Hicks - Collaborator - Queen's University Belfast
Hui Yin - Collaborator - Sir Mortimer B Davis Jewish General Hospital
Jacob (Jay) Udell - Collaborator - University of Toronto
Kristian Filion - Collaborator - McGill University
Lama Sakr - Collaborator - McGill University
Laurent Azoulay - Collaborator - McGill University