title: Lack of an association between angiotensin receptor blocker based therapy and increased risk of cancer: evidence from large observational studies.
abstract: BACKGROUND
  A previous meta-analysis of randomized controlled studies that were not designed to investigate cancer as a primary outcome suggested that ARB-based therapy is associated with increased risk of cancer; however, results of recent observational studies considering the association have been contradictory. This study sought to evaluate the association between angiotensin receptor blocker (ARB)-based therapy and risk of cancer by conducting a meta-analysis of observational studies.
  
  
  METHODS
  Relevant articles published before February 2014 were identified by searching PubMed and the Cochrane Library. Pooled relative risks (RRs) were determined using a random effects model and were used to assess the strength of association between use of ARB-based therapy and risk of cancer.
  
  
  RESULTS
  Six retrospective cohort studies involving a total of 3,827,109 participants and four case-control studies involving a total of 193,029 cases were included. The present study found that ARB-based therapy was not significantly associated with an increased risk of cancer (RR = 0.87, 95%CI: [0.75, 1.01]). However, an analysis including only cohort studies suggested a significantly decreased risk of cancer among individuals with any history of ARB use as compared to those with no history of ARB use (RR = 0.80, 95%CI: [0.55, 0.95]); no significant association was found between ARB use and risk of cancer when the case-control studies were separately considered (RR = 1.03, 95%CI: [0.93, 1.13]). Subgroup analyses showed that use of ARB-based therapy was associated with decreased risk of lung cancer (RR = 0.81, 95%CI: [0.69, 0.94]); however, no significant associations were found with the other cancer sites investigated. Furthermore, no association was observed upon adjustment by type of ARB drug. No publication bias was detected.
  
  
  CONCLUSIONS
  Overall, ARB-based therapy was not associated with increased risk of cancer. However, its use may be related to decreased incidence of lung cancer; this finding should be considered carefully and confirmed with further studies.
authors: Department of Cardiovascular Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
authors: Yuan
authors: Y
authors: Yang
authors: School of Public Health and Health Management, Chongqing Medical University, Chongqing, China.
authors: Fan
authors: F
authors: Zhang
authors: Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America.
authors: Laura
authors: L
authors: Skrip
authors: Department of Cardiovascular Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
authors: Han
authors: H
authors: Lei
authors: Department of Cardiovascular Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
authors: Suxin
authors: S
authors: Luo
authors: Department of Cardiovascular Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
authors: Kai
authors: K
authors: Lu
authors: Department of Cardiovascular Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
authors: Dayi
authors: D
authors: Hu
mesh_terms: D057911:Angiotensin Receptor Antagonists / Q000009:adverse effects* / Q000627:therapeutic use; D015331:Cohort Studies; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D009369:Neoplasms / Q000139:chemically induced / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D057911:Angiotensin Receptor Antagonists