Table 4

Association between post-diagnostic exposure to ACEIs and ARBS and all-cause mortality, by cancer site
Post-diagnostic medication usage All cancer patients Cancer patients with available stage/gradeb
All-cause deaths number (%) Controls number (%) Unadjusted OR (95% CI) P (trendd) Adjusteda OR (95% CI) P (trendd) Unadjusted OR (95% CI) P (trendd) Fully adjusted OR (95% CI)c P (trendd)
Breast cancer
ACEI
  0 (non-user) 1,749 (77.5) 8,948 (80.2) 1.00 (ref. cat.) 1.00 (ref. cat.) 1.00 (ref. cat.) 1.00 (ref. cat.)
  ≥1 DDD (user) 509 (22.5) 2,206 (19.8) 1.19 (1.06, 1.34) 0.003 1.04 (0.92, 1.19) 0.51 1.19 (1.00, 1.41) 0.05 0.93 (0.76, 1.14) 0.49
(0.01) (0.60) (0.09) (0.37)
  1 to 365 DDDs 193 (8.6) 821 (8.6) 1.20 (1.02, 1.42) 0.03 1.06 (0.89, 1.27) 0.52 1.26 (0.97, 1.62) 0.08 1.00 (0.76, 1.34) 0.97
  ≥365 DDDs 316 (14.0) 1,385 (12.4) 1.18 (1.03, 1.36) 0.02 1.03 (0.89, 1.20) 0.68 1.15 (0.94, 1.41) 0.17 0.89 (0.71, 1.13) 0.34
ARB
  0 (non-user) 2,057 (91.1) 10,161 (91.1) 1.00 (ref. cat.) 1.00 (ref. cat.) 1.00 (ref. cat.) 1.00 (ref. cat.)
  ≥1 DDD (user) 201 (8.9) 993 (8.9) 1.00 (0.85, 1.18) 0.99 0.96 (0.81, 1.14) 0.62 0.91 (0.71, 1.16) 0.45 0.79 (0.60 ,1.03) 0.08
(0.85) (0.80) (0.69) (0.18)
  1 to 365 DDDs 64 (2.8) 338 (3.0) 0.93 (0.70, 1.22) 0.59 0.88 (0.66, 1.17) 0.37 0.73 (0.47, 1.15) 0.18 0.62 (0.39, 1.00) 0.05
  ≥365 DDDs 137 (6.1) 655 (5.9) 1.04 (0.85, 1.26) 0.71 1.00 (0.82, 1.23) 0.99 1.00 (0.75, 1.33) 0.99 0.87 (0.64, 1.19) 0.38
Colorectal cancer
ACEI
  0 (non-user) 1,596 (76.0) 7,578 (75.0) 1.00 (ref. cat.) 1.00 (ref. cat.) 1.00 (ref. cat.) 1.00 (ref. cat.)
  ≥1 DDD (user) 505 (24.0) 2,529 (25.0) 0.96 (0.85, 1.07) 0.44 0.90 (0.79, 1.02) 0.10 0.94 (0.82, 1.07) 0.36 0.89 (0.76, 1.03) 0.12
(0.31) (0.05) (0.38) (0.10)
  1 to 365 DDDs 206 (9.8) 985 (9.8) 1.00 (0.86, 1.18) 0.95 0.95 (0.80, 1.13) 0.58 0.94 (0.78, 1.14) 0.55 0.92 (0.75, 1.13) 0.41
  ≥365 DDDs 299 (14.2) 1,544 (15.3) 0.92 (0.80, 1.06) 0.27 0.85 (0.73, 1.00) 0.05 0.94 (0.80, 1.10) 0.43 0.86 (0.72, 1.04) 0.11
ARB
  0 (non-user) 1,939 (92.3) 9,294 (92.0) 1.00 (ref. cat.) 1.00 (ref. cat.) 1.00 (ref. cat.) 1.00 (ref. cat.)
  ≥1 DDD (user) 162 (7.8) 813 (8.0) 0.97 (0.82, 1.16) 0.78 0.94 (0.78, 1.13) 0.50 1.01 (0.82, 1.23) 0.95 1.02 (0.82, 1.26) 0.88
(0.88) (0.86) (0.66) (0.72)
  1 to 365 DDDs 59 (2.8) 344 (3.4) 0.84 (0.64, 1.12) 0.24 0.80 (0.60, 1.06) 0.12 0.85 (0.61, 1.19) 0.35 0.92 (0.65, 1.31) 0.66
  ≥365 DDDs 103 (4.9) 469 (4.6) 1.07 (0.86, 1.34) 0.54 1.05 (0.83, 1.32) 0.70 1.11 (0.86, 1.41) 0.42 1.07 (0.83, 1.39) 0.60
Prostate cancer
ACEI
  0 (non-user) 1,463 (66.6) 7,512 (69.3) 1.00 (ref. cat.) 1.00 (ref. cat.) 1.00 (ref. cat.) 1.00 (ref. cat.)
  ≥1 DDD (user) 734 (33.4) 3,326 (30.7) 1.14 (1.03, 1.26) 0.01 0.91 (0.82, 1.03) 0.13 1.09 (0.97, 1.23) 0.15 0.88 (0.76, 1.00) 0.06
(0.04) (0.05) (0.13) (0.07)
  1 to 365 DDDs 258 (11.7) 1,098 (10.1) 1.20 (1.04, 1.40) 0.01 1.00 (0.85, 1.17) 0.96 1.06 (0.89, 1.27) 0.53 0.88 (0.73, 1.07) 0.20
  ≥365 DDDs 476 (21.7) 2,228 (20.6) 1.11 (0.98, 1.24) 0.09 0.87 (0.76, 0.99) 0.04 1.11 (0.97, 1.27) 0.14 0.87 (0.75, 1.02) 0.09
ARB
  0 (non-user) 2,002 (91.1) 9,873 (91.1) 1.00 (ref. cat.) 1.00 (ref. cat.) 1.00 (ref. cat.) 1.00 (ref. cat.)
  ≥1 DDD (user) 195 (8.9) 965 (8.9) 1.00 (0.85, 1.18) 0.98 0.85 (0.72, 1.01) 0.06 1.08 (0.89, 1.30) 0.45 0.92 (0.75, 1.12) 0.39
(0.99) (0.07) (0.33) (0.56)
  1 to 365 DDDs 61 (2.8) 297 (2.7) 1.02 (0.77, 1.35) 0.89 0.86 (0.64, 1.15) 0.32 0.95 (0.68, 1.33) 0.77 0.81 (0.57, 1.14) 0.26
  ≥365 DDDs 134 (6.1) 668 (6.2) 0.99 (0.82, 1.21) 0.95 0.84 (0.69, 1.03) 0.10 1.14 (0.91, 1.43) 0.26 0.97 (0.76, 1.23) 0.81

aAll 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). bAnalysis includes 1,558 cases and 7,406 controls in colorectal cancer patients with available stage, 1,008 cases and 4,900 controls in breast cancer patients with available stage and 1,520 cases and 7,473 controls in prostate cancer patients with available grade. cAdditionally adjusted for stage in colorectal cancer patients and breast cancer patients and adjusted for grade in prostate cancer patient. dTests for trend from conditional logistic regression model based upon categories of DDDs (0, 1 to365, ≥365 DDDs coded as 0, 1, 2 respectively). 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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