Table 2

Association between post-diagnostic exposure to ACEIs and ARBS and cancer specific death, by cancer site
Post-diagnostic medication usage All cancer patients Cancer patients with available stage/gradec
Cancer specific deaths number (%) Controls number (%) Unadjusted OR (95% CI) P (trenda) Adjustedb OR (95% CI) P (trenda) Unadjusted OR (95% CI) P (trenda) Fully adjusted OR (95% CI)d P (trenda)
Breast cancer
ACEI
  0 (non-user) 1,192 (83.1) 5,938 (83.6) 1.00 (ref. cat.) 1.00 (ref. cat.) 1.00 (ref. cat.) 1.00 (ref. cat.)
  ≥1 DDD (user) 243 (16.9) 1,168 (16.4) 1.04 (0.88, 1.22) 0.65 1.06 (0.89, 1.27) 0.52 0.96 (0.76, 1.21) 0.72 0.83 (0.63, 1.09) 0.18
(0.50) (0.32) (0.88) (0.47)
  1to 365 DDDs 92 (6.4) 469 (6.6) 0.97 (0.77, 1.23) 0.80 0.96 (0.75, 1.24) 0.78 0.88 (0.61, 1.27) 0.49 0.65 (0.43, 0.99) 0.04
  ≥365 DDDs 151 (10.5) 699 (9.8) 1.08 (0.89, 1.32) 0.42 1.14 (0.92, 1.41) 0.25 1.01 (0.76, 1.33) 0.96 0.96 (0.69, 1.34) 0.82
ARB
  0 (non-user) 1,333 (92.9) 6,602 (92.9) 1.00 (ref. cat.) 1.00 (ref. cat.) 1.00 (ref. cat.) 1.00 (ref. cat.)
  ≥1 DDD (user) 102 (7.1) 504 (7.1) 1.00 (0.80, 1.26) 0.98 1.06 (0.84, 1.35) 0.62 1.03 (0.84, 1.25) 0.80 0.94 (0.65, 1.37) 0.75
(0.99) (0.57) (0.69) (0.85)
  1 to 365 DDDs 33 (2.3) 160 (2.3) 1.02 (0.70, 1.51) 0.87 1.01 (0.68, 1.51) 0.96 1.04 (0.58, 1.87) 0.90 0.84 (0.44, 1.61) 0.59
  ≥365 DDDs 69 (4.8) 344 (4.8) 0.99 (0.75, 1.30) 0.95 1.09 (0.82, 1.45) 0.55 1.08 (0.73, 1.60) 0.70 0.99 (0.64, 1.52) 0.95
Colorectal cancer
ACEI
  0 (non-user) 1,231 (81.5) 5,660 (77.6) 1.00 (ref. cat.) 1.00 (ref. cat.) 1.00 (ref. cat.) 1.00 (ref. cat.)
  ≥1 DDD (user) 280 (18.5) 1,631 (22.4) 0.79 (0.69, 0.92) 0.002 0.78 (0.66, 0.92) 0.003 0.75 (0.63, 0.89) 0.001 0.76 (0.62, 0.93) 0.01
(0.01) (0.02) (0.005) (0.02)
  1 to 365 DDDs 113 (7.5) 729 (10.0) 0.72 (0.59, 0.89) 0.002 0.71 (0.57, 0.89) 0.03 0.69 (0.54, 0.90) 0.005 0.71 (0.53, 0.94) 0.02
  ≥365 DDDs 167 (11.1) 902 (12.4) 0.85 (0.71, 1.02) 0.09 0.84 (0.68, 1.03) 0.10 0.80 (0.64, 0.98) 0.03 0.80 (0.63, 1.02) 0.07
ARB
  0 (non-user) 1,428 (94.5) 6,811 (93.4) 1.00 (ref. cat.) 1.00 (ref. cat.) 1.00 (ref. cat.) 1.00 (ref. cat.)
  ≥1 DDD (user) 83 (5.5) 480 (6.6) 0.84 (0.66, 1.07) 0.15 0.82 (0.64, 1.07) 0.14 0.91 (0.76, 1.08) 0.29 0.80 (0.59, 1.09) 0.16
(0.41) (0.94) (0.26) (0.66)
  1 to 365 DDDs 29 (1.9) 221 (3.0) 0.64 (0.43, 0.95) 0.03 0.63 (0.42, 0.94) 0.03 0.51 (0.31, 0.83) 0.01 0.61 (0.37, 1.03) 0.06
  ≥365 DDDs 54 (3.6) 259 (3.6) 1.00 (0.74, 1.36) 0.98 1.00 (0.72, 1.37) 0.98 0.98 (0.69, 1.38) 0.89 0.93 (0.64, 1.36) 0.72
Prostate cancer
ACEI
  0 (non-user) 848 (71.6) 4,145 (70.9) 1.00 (ref. cat.) 1.00 (ref. cat.) 1.00 (ref. cat.) 1.00 (ref. cat.)
  ≥1 DDD (user) 336 (28.4) 1,704 (29.1) 0.96 (0.83, 1.10) 0.55 0.78 (0.66, 0.92) 0.003 0.98 (0.82, 1.17) 0.80 0.82 (0.67, 1.02) 0.07
(0.47) (0.003) (0.85) (0.11)
  1 to 365 DDDs 118 (10.0) 572 (9.8) 1.00 (0.81, 1.24) 0.99 0.83 (0.66, 1.04) 0.11 0.96 (0.74, 1.26) 0.79 0.80 (0.59, 1.07) 0.14
  ≥365 DDDs 218 (18.4) 1,132 (19.4) 0.94 (0.79, 1.11) 0.44 0.75 (0.62, 0.91) 0.003 0.98 (0.80, 1.21) 0.88 0.84 (0.66, 1.07) 0.16
ARB
  0 (non-user) 1,103 (93.2) 5,384 (92.1) 1.00 (ref. cat.) 1.00 (ref. cat.) 1.00 (ref. cat.) 1.00 (ref. cat.)
  ≥1 DDD (user) 81 (6.8) 465 (8.0) 0.86 (0.67, 1.10) 0.22 0.79 (0.61,1.03) 0.08 0.93 (0.70, 1.23) 0.62 0.82 (0.61, 1.11) 0.21
(0.16) (0.06) (0.75) (0.26)
  1 to 365 DDDs 30 (2.5) 153 (2.6) 0.97 (0.65, 1.44) 0.88 0.88 (0.58, 1.33) 0.55 0.84 (0.52, 1.36) 0.48 0.77 (0.46, 1.29) 0.33
  ≥365 DDDs 51 (4.3) 312 (5.3) 0.80 (0.59, 1.09) 0.15 0.74 (0.54, 1.02) 0.07 0.98 (0.70, 1.36) 0.90 0.84 (0.59, 1.21) 0.36

aTests for trend from conditional logistic regression model based upon categories of DDDs (0, 1 to 365, ≥365 DDDs coded as 0, 1, 2, respectively). bAll models include surgery (within six months of diagnosis), chemotherapy (within six months), radiotherapy (within six months), low dose aspirin (during exposure period), statins (during exposure period), comorbidities (pre-diagnosis or during exposure period, including myocardial infarction, cerebrovascular disease, congestive heart disease, chronic pulmonary disease, peripheral vascular disease, renal disease, peptic ulcer disease and diabetes), and smoking (pre-diagnosis, with missing included as a category). The breast cancer model additionally includes tamoxifen (within six months), aromatase inhibitors (within six months), hormone replacement therapy (pre-diagnosis). The prostate cancer model additionally includes androgen therapy (within six months). cAnalysis includes 1,093 cases and 5,231 controls in colorectal cancer patients with available stage, 648 cases and 3,193 controls in breast cancer patients with available stage and 766 cases and 3,777 controls in prostate cancer patients with available grade. dAdditionally adjusted for stage in colorectal cancer patients and breast cancer patients and adjusted for grade in prostate cancer patients. ACEIs, angiotensin-converting enzyme inhibitors; ARBs, angiotensin II receptor blockers; CI, confidence interval; DDDs, daily defined doses; OR, odds ratio.

Cardwell et al.

Cardwell et al. BMC Medicine 2014 12:28   doi:10.1186/1741-7015-12-28

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