Friday, September 30, 2011


The month of September 2011, may be noted as the month with new data on cancer risk. That dreaded disease with much morbidity and mortality. Avoiding cancers become and important part of adult life.

Firstly, The Sept 19th issue of the American Journal of Transplantation, carried a piece of work by the workers in Heidelberg University, Germany. Led by Dr Gerhard Opelz, they looked into the Collaborative Transplant registry. This is a prospective transplant registry involving 400 international transplant centers. This registry, across 400 centers, involving 24,000 patients, was tracking patients since 1998. They looked at the patients who were transplanted, who were using either ACE-I or ARB, and who smoked. Of course, transplanted patients, because of the immunosuppressives that they are on, are at higher risk of cancers. Dr Opelz and colleagues, found that there was a correlation between the use of ACE-I and ARB, smoking and lung cancers. Those who were on ACE-I or ARB but who do not smoke had no such association.
This study then join the growing list of studies which showed that there may be a correlation between ACE-I / ARB and cancers.
It looks like on this issue, there are now two camps. The pro ACE-I / ARB cancer risk camp would include this study, the Sapahi study, the DIRECT study. The anti ACE-I / ARB cancer risk camp would include the FDA announce earlier this year, the Bangalore study, and the ARB Collaboration Trialist. I do not think we have heard the end of this story yet.

The second was a presentation at the 2011 European Multi-discipline Cancer Congress. This was held recently at Stockholm. At this meeting, Dr Mieke Van Hemelrijck and colleague from the King's College, London, reviewed, the records of about 560,000 patients from the Me-Can project ( Metabolic Syndrome - Cancer project ). This project collects data from cancer patients across Europe, from Norway, Sweden and Austria. They studied patients who have a record of two or more BP readings to see who has hypertension. After 12 years of follow-up, they found that those patients who fulfilled the criteria of hypertension, had a correlation with cancers, amongst the males. With the females, there was correlation was not statistically significant. Hypertension, in this cohort, was associated with cancers, in males, like ca lung, colorectal ca, oral ca, bladder ca. There was no correlation with one type of cancer.
They concluded that in males, a history of hypertension may put you at risk of cancers. This study again is an observational data, but because it involved half a million patients followed up for 12 years, it must carry some message for us. Unfortunately, this study, does not record the drugs that those hypertensives were on. I am not sure if the King's College workers will look into that issue now. Perhaps they can throw some light into the issue of ACE-I / ARB and cancers, as it is very lightly that many of those hypertensives in their cohort, could be on ACE-I / ARB.

I suppose, the take home message would be to keep a healthy lifestyle ( as if we do not know that ), and take drugs only if you really have to. Good drugs ( presently ), may later be shown to be harmful ( in 10 years time ). One never knows.

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