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2018 ; 18
(1
): 401
Nephropedia Template TP
gab.com Text
Twit Text FOAVip
Twit Text #
English Wikipedia
Comparative effectiveness of angiotensin-converting enzyme inhibitors and
angiotensin II receptor blockers in chemoprevention of hepatocellular carcinoma:
a nationwide high-risk cohort study
#MMPMID29631561
Ho CM
; Lee CH
; Lee MC
; Zhang JF
; Wang JY
; Hu RH
; Lee PH
BMC Cancer
2018[Apr]; 18
(1
): 401
PMID29631561
show ga
BACKGROUND: Research has revealed that angiotensin-converting enzyme inhibitors
(ACEIs) and angiotensin II receptor blockers (ARBs) may prevent cancers such as
hepatocellular carcinoma (HCC). The comparative chemopreventive effects of ACEIs
and ARBs in high-risk populations with hepatitis B virus (HBV) or hepatitis C
virus (HCV) infection have yet to be investigated. METHODS: From 2005 to 2014,
high-risk HBV and HCV cohorts of hypertensive patients without HCC history were
recruited from three linked national databases of Taiwan, and were classified
into two groups based on the ACEI or ARB exposure within the initial six months
after initiating antiviral agent. Intergroup differences in clinical
characteristics and duration of drug exposure within study period were evaluated.
HCC-free survival was compared using the log-rank test. Multivariate Cox
regression including time-dependent variables for the use of ACEIs or ARBs and
other medications was applied to adjust for confounders. RESULTS: Among the 7724
patients with HBV and 7873 with HCV, 46.3% and 42.5%, respectively, had an
initial exposure to ACEIs or ARBs. The median durations of exposure were 36.4 and
38.9 months for the HBV and HCV cohorts, respectively. The median durations of
ACEI or ARB use during study period between initial exposure and nonexposure
groups were 41.8 vs. 18.3 months and 46.4 vs. 22.7 months for the HBV and HCV
cohorts, respectively. No significant difference was observed in HCC risk within
7 years between the initial exposure and non-exposure groups. After adjustment
for comorbidities, namely liver cirrhosis, diabetes mellitus (DM), and
hyperlipidemia, and medications, namely aspirin, metformin, and statins, the
hazard ratios (HRs) for ACEI or ARB exposure for HCC risk were 0.97 (95%
confidence interval [CI]: 0.81-1.16) and 0.96 (0.80-1.16) in the HBV and HCV
cohorts, respectively. In the HCV cohort, the increased HCC risk was associated
with ACEI or ARB use in patients without cirrhosis, DM, and hyperlipidemia (HR:
4.53, 95% CI: 1.46-14.1). CONCLUSION: Compared with other significant risk and
protective factors for HCC, ACEI or ARB use in the HBV and HCV cohorts was not
associated with adequate protective effectiveness under standard dosages and may
not be completely safe.
|*Chemoprevention
[MESH]
|Aged
[MESH]
|Angiotensin Receptor Antagonists/*therapeutic use
[MESH]
|Angiotensin-Converting Enzyme Inhibitors/*therapeutic use
[MESH]
|Carcinoma, Hepatocellular/etiology/mortality/*prevention & control
[MESH]
|Comorbidity
[MESH]
|Female
[MESH]
|Follow-Up Studies
[MESH]
|Hepatitis B/complications/virology
[MESH]
|Hepatitis C/complications/virology
[MESH]
|Humans
[MESH]
|Liver Neoplasms/etiology/mortality/*prevention & control
[MESH]