Teo, K.K. et al. (2011) Effects of telmisartan, irbesartan, valsartan, candesartan, and losartan on cancers in 15 trials enrolling 138,769 individuals. The ARB Trialists Collaboration. Journal of Hypertension, 29(4), pp. 623-635. (doi: 10.1097/HJH.0b013e328344a7de)
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Abstract
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
Item Type: | Articles |
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Status: | Published |
Refereed: | Yes |
Glasgow Author(s) Enlighten ID: | McMurray, Professor John |
Authors: | Teo, K.K., Sleight, P., Gao, P., Yusuf, S., Connolly, S., Swedberg, K., Pfeffer, M.A., Granger, C.B., McMurray, J.,J.,V., Sjoelie, A.K., Massie, B.M., Carson, P., Lewis, J.B., Wachtell, K., Dahlof, B., Devereux, R.B., Kjeldsen, S.E., Julius, S., Ibsen, H., Lindholm, L.H., Olsen, M.H., Okin, P.M., Califf, R., Holman, R.R., Haffner, S.M., Dagenais, G., Probstfield, J., Anderson, C., Diaz, R., Dans, A., Levine, M., Unger, T., Fagard, R., Diener, H.C., Sacco, R.L., Zanchetti, A., Cohn, J.N., and Weber, M. |
College/School: | College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health |
Journal Name: | Journal of Hypertension |
Publisher: | Lippincott Williams & Wilkins |
ISSN: | 0263-6352 |
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