Does a Common Heart Medication Raise Your Risk for Lung Cancer?

Researchers now want to know if one of the most popular drugs prescribed to cut that cardiac risk is increasing the risk of lung cancer instead.
Angiotensin converting enzyme (ACE) inhibitors are heart medications that expand blood vessels, improving circulation and reducing the heart’s workload.
“ACE inhibitors are the mainstay of treatment, not just for high blood pressure, but also for congestive heart failure and to prevent heart attacks,” Dr. Syed Jafri, an oncologist with McGovern Medical School at UTHealth/UT Physicians and Memorial Hermann Hospital in Texas, told Healthline.
ACE inhibitors are even prescribed to prevent kidney damage in some cases of type 2 diabetes.
The most common side effect is a persistent dry cough. Other possible side effects may include headache, dizziness, or rash.
An unsettling discovery
According to an observational study recently published in The BMJ, researchers found ACE inhibitors were associated with an increased risk of lung cancer when compared with a similar type of blood pressure medication known as angiotensin receptor blockers (ARBs).
“ARBs and ACE inhibitors work in very similar ways to control blood pressure, the biggest difference being that ACE inhibitors can increase levels of two substances in the lungs: bradykinin and substance P,” Jafri said.
“ACE inhibitors,” he added, “can also cause coughing in certain patients. In these cases, ARBs are usually substituted to relieve this symptom.”
Canadian researchers working at the Jewish General Hospital and the University of Toronto used the records of 992,061 British patients who were first prescribed blood pressure drugs between January 1995 and December 2015.
They identified 335,000 patients who were treated with ACE inhibitors, 29,000 with ARBs, and 101,000 who were prescribed both ACE and ARB inhibitors.
The most commonly prescribed drugs were ramipril, lisinopril, and perindopril.
All the study participants had at least one year of health records before and after their first prescription of an ACE inhibitor, ARB, or other blood pressure drug, including beta-blockers and calcium channel blockers.
Lung cancer was diagnosed in 7,952 of the 900,000 patient cohort over a six-year follow-up period.
After researchers considered smoking and other potential factors, ACE inhibitor use was associated with a 14 percent increased risk for lung cancer compared to ARB use.
That risk increased to 31 percent after 10 years.
Asked if the risk of lung cancer outweighed the benefits of taking ACE inhibitors, Jafri said, “I don’t think so. I think the benefit of using ACE inhibitors far outweighs the comparatively small risk of lung cancer.”
“However, in patients who are already at high risk due to heavy smoking, their doctor may want to discuss quitting before prescribing this type of medication,” Jafri cautioned.