title: Reduced risk of breast cancer recurrence in patients using ACE inhibitors, ARBs, and/or statins.
abstract: BACKGROUND
  Epidemiologic and biochemical evidence suggest a role of statins and angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs) as anti-neoplastic agents. This study was designed to evaluate the association between the use of these agents and the risk of breast cancer recurrence.
  
  
  METHODS
  We reviewed the medical records of patients treated for stage II/III breast cancer between 1999 and 2005. Statin and ACE-inhibitors/ARB users were defined as patients who took these medications for at least 6 months in no evidence of disease (NED) stage after the initial diagnosis. The primary outcome was disease-free survival and the secondary was overall survival. The Kaplan-Meier and Cox proportional hazard models were used.
  
  
  RESULTS
  A total of 703 patients were included. The median and maximal of follow up was 55 and 118 months, respectively. A total of 168 patients used ACE-inhibitors/ARBs, 156 patients used statins, and 81 used both. Univariate analysis showed significant reduction in breast cancer recurrence among patients who used ACE-inhibitors/ARBs (hazard ratio (HR) = 0.57; 95% CI: 0.37-0.89; p = .013) or statins (HR = 0.43; 95% CI: 0.26-0.70; p < .001). After adjusting for multiple variables, the use of ACE-inhibitors/ARBs (HR = 0.49; 95% CI: 0.31-0.76; p = .002) and statins (HR = 0.40; 95% CI: 0.24-0.67; p < .001) remained significant and an additive effect was found on those who used both drugs (HR = 0.30 95% CI: 0.15-0.61; p = .001). No association was found regarding overall survival.
  
  
  CONCLUSIONS
  The use of ACE-inhibitors/ARBs, statins, and the combination of both were all associated with a reduced risk of breast cancer recurrence. This observation should prompt further exploration.
authors.affiliation: Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. ykchae@mdanderson.org
authors.forename: Young Kwang
authors.initials: YK
authors.lastname: Chae
authors.forename: Matias E
authors.initials: ME
authors.lastname: Valsecchi
authors.forename: Jongoh
authors.initials: J
authors.lastname: Kim
authors.forename: Anabella Lucca
authors.initials: AL
authors.lastname: Bianchi
authors.forename: Danai
authors.initials: D
authors.lastname: Khemasuwan
authors.forename: Ajit
authors.initials: A
authors.lastname: Desai
authors.forename: William
authors.initials: W
authors.lastname: Tester
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000453:epidemiology; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000517:prevention & control*; D010414:Pennsylvania / Q000453:epidemiology; D012307:Risk Factors; D055815:Young Adult
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors