title: Use of angiotensin-converting-enzyme inhibitors or angiotensin-receptor blockers and cancer risk: a meta-analysis of observational studies.
abstract: BACKGROUND
  Epidemiologic studies have reported inconsistent findings regarding the association between the use of angiotensin-converting-enzyme (ACE) inhibitors or angiotensin-receptor blockers and the risk of cancer. We performed a meta-analysis of observational studies to assess the association.
  
  
  METHODS
  We searched MEDLINE, EMBASE and the Cochrane Library to identify studies through January 2011. Two evaluators independently reviewed and selected articles of cohort and case-control studies on the basis of predetermined selection criteria.
  
  
  RESULTS
  Of 3970 screened articles, 12 cohort studies and 16 case-control studies were selected for analysis. We found no significant association between the use of ACE inhibitors or angiotensin-receptor blockers and the overall risk of cancer (relative risk [RR] 0.96, 95% confidence interval [CI] 0.90-1.03). We found a decreased risk of cancer associated with use of either medication when we restricted the analyses to cohort and nested case-control studies (RR 0.90, 95% CI 0.83-0.97) or to studies with long-term follow-up of more than five years (RR 0.89, 95% CI 0.83-0.96). In the subgroup meta-analyses by cancer site, a decreased risk was identified for esophageal cancer, whereas an increased risk was found for melanoma and kidney cancer.
  
  
  CONCLUSIONS
  No significant association was found between the use of ACE inhibitors or angiotensin-receptor blockers and overall risk of cancer. A possible beneficial effect associated with use of either medication was suggested in sensitivity analyses, including those of studies with long-term follow-up. Large randomized controlled trials with long-term follow-up are needed to specifically test the effect of each of these medications on the risk of cancer.
authors.affiliation: Seoul National University College of Medicine, Seoul, Republic of Korea.
authors.forename: Chan
authors.initials: C
authors.lastname: Yoon
authors.forename: Hyun-Sik
authors.initials: HS
authors.lastname: Yang
authors.forename: Inpyo
authors.initials: I
authors.lastname: Jeon
authors.forename: Yoosoo
authors.initials: Y
authors.lastname: Chang
authors.forename: Sang Min
authors.initials: SM
authors.lastname: Park
mesh_terms: D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D015340:Epidemiologic Research Design; D004938:Esophageal Neoplasms / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007680:Kidney Neoplasms / Q000453:epidemiology; D009369:Neoplasms / Q000453:epidemiology*; D018570:Risk Assessment
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors