title: Angiotensin-converting enzyme inhibitors/angiotensin receptor blockers therapy and colorectal cancer: a systematic review and meta-analysis.
abstract: OBJECTIVE
  We aim to investigate the association between angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs) therapy and colorectal cancer (CRC) by conducting a systematic review with meta-analysis.
  
  
  METHODS
  Literature was searched on PubMed, Scopus, and the Cochrane library to identify relevant studies evaluating ACEIs/ARBs therapy and risk of CRC incidence or survival of CRC patients. Pooled risk ratio (RR) with 95% confidence intervals was calculated for the association between ACEIs/ARBs and CRC risk and mortality.
  
  
  RESULTS
  Eleven observational studies were included in the systematic review. A meta-analysis of six studies totaling 113,048 individuals indicated a 6% decreased risk of CRC in ACEIs/ARBs users compared to non-users (95% CI 0.89-0.98). In the four case-control studies, individuals using ACEIs/ARBs were associated with a 6% decreased risk of CRC (95% CI 0.90-0.99). The meta-analysis of three studies investigating the relationship between ACEIs/ARBs and survival of CRC did not show a significantly decreased mortality in ACEIs/ARBs users (RR 0.81, 95% CI 0.60-1.09). Seven studies evaluated the dose-response relationship between ACEIs/ARBs therapy and CRC, and two of them showed that the association was related to longer duration and higher dose.
  
  
  CONCLUSIONS
  CEIs/ARBs therapy might be associated with a reduce risk of CRC development, but whether use of these medications improves the outcomes of CRC remains unknown. Large-scale and more robust studies are needed to further explore this association.
authors.affiliation: Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou, Zhejiang, China.
authors.forename: Yi-Ning
authors.initials: YN
authors.lastname: Dai
authors.forename: Jing-Hua
authors.initials: JH
authors.lastname: Wang
authors.forename: Jin-Zhou
authors.initials: JZ
authors.lastname: Zhu
authors.forename: Jie-Qiong
authors.initials: JQ
authors.lastname: Lin
authors.forename: Chao-Hui
authors.initials: CH
authors.lastname: Yu
authors.forename: You-Ming
authors.initials: YM
authors.lastname: Li
mesh_terms: D057911:Angiotensin Receptor Antagonists / Q000009:adverse effects* / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D015179:Colorectal Neoplasms / Q000453:epidemiology* / Q000209:etiology*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D015994:Incidence; D012306:Risk
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors