Taking angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) is associated with a decreased risk of colorectal cancer within three years of colonoscopy, according to the results of a new study.
By inhibiting or blocking angiotensin, a protein that raises blood pressure by constricting the arteries, ACE inhibitors and ARBs treat heart disease, heart failure, and high blood pressure. Whether ACE inhibitors and ARBs can also play a role in cancer prevention, however, has remained controversial.
In a retrospective study now published in Hypertension, a team of researchers led by first author Ka Shing Cheung, MD, a Clinical Professor of Medicine at the University of Hong Kong, investigated the association between ACE inhibitor and ARB use and the development of colorectal cancer. The study included adult patients aged 40 and older who had a negative baseline colonoscopy between 2005 and 2013 in Hong Kong. Patients with inflammatory bowel disease, those with prior colorectal cancer or colectomy, and those whose colorectal cancer was diagnosed less than six months after undergoing colonoscopy were excluded. Of 187,897 patients included in the study, 16.4% used ACE inhibitors or ARBs at least 180 days within five years before their colonoscopy.
Among the overall study population, 854 patients (0.45%) developed colorectal cancer within six to 36 months after colonoscopy. Use of ACE inhibitors and ARBs was associated with a 22% lower risk of developing colorectal cancer within three years (hazard ratio 0.78) but was not associated with a reduced risk of developing colorectal cancer more than three years after colonoscopy. For every single-year increase in ACE inhibitor or ARB use, the adjusted hazard ratio for colorectal cancer risk decreased by 5%.
"Our results provide new insights on a potential role of these medications for colorectal cancer prevention. This is the first study to show the potential beneficial effects of ACE inhibitors and ARBs on colorectal cancer development, based on a large group of patients who were colorectal cancer-free at the beginning of the study," commented Wai K. Leung, MD, Clinical Professor of Medicine at the University of Hong Kong and senior author of the study. "While ACE inhibitors and ARBs are taken by patients with high blood pressure, heart failure, and kidney diseases, the reduction in colorectal cancer risk may be an additional factor for physicians to consider when choosing anti-hypertensive medications."
For More Information
Cheung KS, Chan EW, Seto WK, et al (2020). ACE (angiotensin-converting enzyme) inhibitors/angiotensin receptor blockers are associated with lower colorectal cancer risk. Hypertension. [Epub ahead of print] DOI:10.1161/hypertensionaha.120.15317
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