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Table 2 Association between post-diagnostic exposure to ACEIs and ARBS and cancer specific death, by cancer site

From: Drugs affecting the renin-angiotensin system and survival from cancer: a population based study of breast, colorectal and prostate cancer patient cohorts

Post-diagnostic medication usage

All cancer patients

Cancer patients with available stage/gradec

 

Cancer specific deaths number (%)

Controls number (%)

Unadjusted OR (95% CI)

P(trenda)

AdjustedbOR (95% CI)

P(trenda)

Unadjusted OR (95% CI)

P(trenda)

Fully adjusted OR (95% CI)d

P(trenda)

 

Breast cancer

       

ACEI

        

  0 (non-user)

1,192 (83.1)

5,938 (83.6)

1.00 (ref. cat.)

 

1.00 (ref. cat.)

 

1.00 (ref. cat.)

 

1.00 (ref. cat.)

 

  ≥1 DDD (user)

243 (16.9)

1,168 (16.4)

1.04 (0.88, 1.22)

0.65

1.06 (0.89, 1.27)

0.52

0.96 (0.76, 1.21)

0.72

0.83 (0.63, 1.09)

0.18

    

(0.50)

 

(0.32)

 

(0.88)

 

(0.47)

  1to 365 DDDs

92 (6.4)

469 (6.6)

0.97 (0.77, 1.23)

0.80

0.96 (0.75, 1.24)

0.78

0.88 (0.61, 1.27)

0.49

0.65 (0.43, 0.99)

0.04

  ≥365 DDDs

151 (10.5)

699 (9.8)

1.08 (0.89, 1.32)

0.42

1.14 (0.92, 1.41)

0.25

1.01 (0.76, 1.33)

0.96

0.96 (0.69, 1.34)

0.82

ARB

          

  0 (non-user)

1,333 (92.9)

6,602 (92.9)

1.00 (ref. cat.)

 

1.00 (ref. cat.)

 

1.00 (ref. cat.)

 

1.00 (ref. cat.)

 

  ≥1 DDD (user)

102 (7.1)

504 (7.1)

1.00 (0.80, 1.26)

0.98

1.06 (0.84, 1.35)

0.62

1.03 (0.84, 1.25)

0.80

0.94 (0.65, 1.37)

0.75

    

(0.99)

 

(0.57)

 

(0.69)

 

(0.85)

  1 to 365 DDDs

33 (2.3)

160 (2.3)

1.02 (0.70, 1.51)

0.87

1.01 (0.68, 1.51)

0.96

1.04 (0.58, 1.87)

0.90

0.84 (0.44, 1.61)

0.59

  ≥365 DDDs

69 (4.8)

344 (4.8)

0.99 (0.75, 1.30)

0.95

1.09 (0.82, 1.45)

0.55

1.08 (0.73, 1.60)

0.70

0.99 (0.64, 1.52)

0.95

   

Colorectal cancer

       

ACEI

         

  0 (non-user)

1,231 (81.5)

5,660 (77.6)

1.00 (ref. cat.)

 

1.00 (ref. cat.)

 

1.00 (ref. cat.)

 

1.00 (ref. cat.)

 

  ≥1 DDD (user)

280 (18.5)

1,631 (22.4)

0.79 (0.69, 0.92)

0.002

0.78 (0.66, 0.92)

0.003

0.75 (0.63, 0.89)

0.001

0.76 (0.62, 0.93)

0.01

    

(0.01)

 

(0.02)

 

(0.005)

 

(0.02)

  1 to 365 DDDs

113 (7.5)

729 (10.0)

0.72 (0.59, 0.89)

0.002

0.71 (0.57, 0.89)

0.03

0.69 (0.54, 0.90)

0.005

0.71 (0.53, 0.94)

0.02

  ≥365 DDDs

167 (11.1)

902 (12.4)

0.85 (0.71, 1.02)

0.09

0.84 (0.68, 1.03)

0.10

0.80 (0.64, 0.98)

0.03

0.80 (0.63, 1.02)

0.07

ARB

          

  0 (non-user)

1,428 (94.5)

6,811 (93.4)

1.00 (ref. cat.)

 

1.00 (ref. cat.)

 

1.00 (ref. cat.)

 

1.00 (ref. cat.)

 

  ≥1 DDD (user)

83 (5.5)

480 (6.6)

0.84 (0.66, 1.07)

0.15

0.82 (0.64, 1.07)

0.14

0.91 (0.76, 1.08)

0.29

0.80 (0.59, 1.09)

0.16

    

(0.41)

 

(0.94)

 

(0.26)

 

(0.66)

  1 to 365 DDDs

29 (1.9)

221 (3.0)

0.64 (0.43, 0.95)

0.03

0.63 (0.42, 0.94)

0.03

0.51 (0.31, 0.83)

0.01

0.61 (0.37, 1.03)

0.06

  ≥365 DDDs

54 (3.6)

259 (3.6)

1.00 (0.74, 1.36)

0.98

1.00 (0.72, 1.37)

0.98

0.98 (0.69, 1.38)

0.89

0.93 (0.64, 1.36)

0.72

   

Prostate cancer

       

ACEI

          

  0 (non-user)

848 (71.6)

4,145 (70.9)

1.00 (ref. cat.)

 

1.00 (ref. cat.)

 

1.00 (ref. cat.)

 

1.00 (ref. cat.)

 

  ≥1 DDD (user)

336 (28.4)

1,704 (29.1)

0.96 (0.83, 1.10)

0.55

0.78 (0.66, 0.92)

0.003

0.98 (0.82, 1.17)

0.80

0.82 (0.67, 1.02)

0.07

    

(0.47)

 

(0.003)

 

(0.85)

 

(0.11)

  1 to 365 DDDs

118 (10.0)

572 (9.8)

1.00 (0.81, 1.24)

0.99

0.83 (0.66, 1.04)

0.11

0.96 (0.74, 1.26)

0.79

0.80 (0.59, 1.07)

0.14

  ≥365 DDDs

218 (18.4)

1,132 (19.4)

0.94 (0.79, 1.11)

0.44

0.75 (0.62, 0.91)

0.003

0.98 (0.80, 1.21)

0.88

0.84 (0.66, 1.07)

0.16

ARB

          

  0 (non-user)

1,103 (93.2)

5,384 (92.1)

1.00 (ref. cat.)

 

1.00 (ref. cat.)

 

1.00 (ref. cat.)

 

1.00 (ref. cat.)

 

  ≥1 DDD (user)

81 (6.8)

465 (8.0)

0.86 (0.67, 1.10)

0.22

0.79 (0.61,1.03)

0.08

0.93 (0.70, 1.23)

0.62

0.82 (0.61, 1.11)

0.21

    

(0.16)

 

(0.06)

 

(0.75)

 

(0.26)

  1 to 365 DDDs

30 (2.5)

153 (2.6)

0.97 (0.65, 1.44)

0.88

0.88 (0.58, 1.33)

0.55

0.84 (0.52, 1.36)

0.48

0.77 (0.46, 1.29)

0.33

  ≥365 DDDs

51 (4.3)

312 (5.3)

0.80 (0.59, 1.09)

0.15

0.74 (0.54, 1.02)

0.07

0.98 (0.70, 1.36)

0.90

0.84 (0.59, 1.21)

0.36

  1. aTests for trend from conditional logistic regression model based upon categories of DDDs (0, 1 to 365, ≥365 DDDs coded as 0, 1, 2, respectively). bAll models include surgery (within six months of diagnosis), chemotherapy (within six months), radiotherapy (within six months), low dose aspirin (during exposure period), statins (during exposure period), comorbidities (pre-diagnosis or during exposure period, including myocardial infarction, cerebrovascular disease, congestive heart disease, chronic pulmonary disease, peripheral vascular disease, renal disease, peptic ulcer disease and diabetes), and smoking (pre-diagnosis, with missing included as a category). The breast cancer model additionally includes tamoxifen (within six months), aromatase inhibitors (within six months), hormone replacement therapy (pre-diagnosis). The prostate cancer model additionally includes androgen therapy (within six months). cAnalysis includes 1,093 cases and 5,231 controls in colorectal cancer patients with available stage, 648 cases and 3,193 controls in breast cancer patients with available stage and 766 cases and 3,777 controls in prostate cancer patients with available grade. dAdditionally adjusted for stage in colorectal cancer patients and breast cancer patients and adjusted for grade in prostate cancer patients. ACEIs, angiotensin-converting enzyme inhibitors; ARBs, angiotensin II receptor blockers; CI, confidence interval; DDDs, daily defined doses; OR, odds ratio.