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Volume 12
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10.3390/cancers12030747
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Article

Association between Angiotensin-Converting Enzyme Inhibitors and Lung Cancer—A Nationwide, Population-Based, Propensity Score-Matched Cohort Study

by
Shih-Yi Lin
1,2,
Cheng-Li Lin
3,4,
Cheng-Chieh Lin
1,5,
Wu-Huei Hsu
1,6,
Chia-Der Lin
1,7,
I.-Kuan Wang
1,2,
Chung-Y. Hsu
1 and
Chia-Hung Kao
1,8,9,10,*
1
Graduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University, Taichung 40447, Taiwan
2
Division of Nephrology and Kidney Institute, China Medical University Hospital, Taichung, Taiwan
3
Management Office for Health Data, China Medical University Hospital, Taichung 40447, Taiwan
4
College of Medicine, China Medical University, Taichung 40447, Taiwan
5
Department of Family Medicine, China Medical University Hospital, Taichung 40447, Taiwan
6
Department of Chest Medicine, China Medical University Hospital, Taichung 40447, Taiwan
7
Department of Otolaryngology, China Medical University Hospital, Taichung 40447, Taiwan
8
Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung 40447, Taiwan
9
Department of Bioinformatics and Medical Engineering, Asia University, Taichung 40447, Taiwan
10
Center of Augmented Intelligence in Healthcare, China Medical University Hospital, Taichung 40447, Taiwan
*
Author to whom correspondence should be addressed.
Cancers 2020, 12(3), 747; https://doi.org/10.3390/cancers12030747
Submission received: 10 February 2020 / Revised: 10 March 2020 / Accepted: 20 March 2020 / Published: 21 March 2020
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Abstract

Background: Direct evidence of lung cancer risk in Asian users of angiotensin-converting enzyme inhibitors (ACEIs) is lacking. Methods: The ACEI cohort comprised 22,384 patients aged ≥ 18 years with a first prescription of ACEI. The comparison angiotensin receptor blocker (ARB) cohort consisted of age-, sex- and comorbidity-matched patients at a ratio of 1:1. The primary outcome was the incidence of lung cancer, which was evaluated using a proportional hazard model. Results: The overall incidence rates of lung cancer in the ACEI and ARB cohorts were 16.6 and 12.2 per 10,000 person-years, respectively. The ACEI cohort had a significantly higher risk of lung cancer than the ARB cohort (adjusted hazard ratio [aHR]. = 1.36; 95% confidence interval [CI]. = 1.11–1.67). Duration–response and dose–response analyses revealed that compared with patients who did not receive ACEIs, patients who received ACEIs for more than 45 days per year (aHR = 1.87; 95% CI = 1.48–2.36) and patients who received more than 540 defined daily doses of ACEIs per year (aHR =1.80; 95% CI = 1.43–-2.27) had a significantly higher risk of lung cancer. The cumulative incidence of lung cancer was also significantly higher in the ACEI cohort than in the ARB cohort (log-rank test, p = 0.002). Conclusions: ACEI use is associated with an increased risk of lung cancer compared with ARB use. Patients using ARBs have a significantly lower risk of lung cancer than non-ARB users.
Keywords: angiotensin-converting enzyme inhibitors (ACEIs); lung cancer; air pollutant angiotensin-converting enzyme inhibitors (ACEIs); lung cancer; air pollutant

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MDPI and ACS Style

Lin, S.-Y.; Lin, C.-L.; Lin, C.-C.; Hsu, W.-H.; Lin, C.-D.; Wang, I.-K.; Hsu, C.-Y.; Kao, C.-H. Association between Angiotensin-Converting Enzyme Inhibitors and Lung Cancer—A Nationwide, Population-Based, Propensity Score-Matched Cohort Study. Cancers 2020, 12, 747. https://doi.org/10.3390/cancers12030747

AMA Style

Lin S-Y, Lin C-L, Lin C-C, Hsu W-H, Lin C-D, Wang I-K, Hsu C-Y, Kao C-H. Association between Angiotensin-Converting Enzyme Inhibitors and Lung Cancer—A Nationwide, Population-Based, Propensity Score-Matched Cohort Study. Cancers. 2020; 12(3):747. https://doi.org/10.3390/cancers12030747

Chicago/Turabian Style

Lin, Shih-Yi, Cheng-Li Lin, Cheng-Chieh Lin, Wu-Huei Hsu, Chia-Der Lin, I.-Kuan Wang, Chung-Y. Hsu, and Chia-Hung Kao. 2020. "Association between Angiotensin-Converting Enzyme Inhibitors and Lung Cancer—A Nationwide, Population-Based, Propensity Score-Matched Cohort Study" Cancers 12, no. 3: 747. https://doi.org/10.3390/cancers12030747

APA Style

Lin, S.-Y., Lin, C.-L., Lin, C.-C., Hsu, W.-H., Lin, C.-D., Wang, I.-K., Hsu, C.-Y., & Kao, C.-H. (2020). Association between Angiotensin-Converting Enzyme Inhibitors and Lung Cancer—A Nationwide, Population-Based, Propensity Score-Matched Cohort Study. Cancers, 12(3), 747. https://doi.org/10.3390/cancers12030747

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