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Renin angiotensin system inhibitors may attenuate low LDL cholesterol‐related cancer risk in type 2 diabetes
Author(s) -
Yang Xilin,
Ma Ronald C. W.,
So Wing Yee,
Wang Ying,
Kong Alice P. S.,
Ozaki Risa,
Xu Gang,
Chan Juliana C. N.
Publication year - 2014
Publication title -
diabetes/metabolism research and reviews
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.307
H-Index - 110
eISSN - 1520-7560
pISSN - 1520-7552
DOI - 10.1002/dmrr.2504
Subject(s) - hazard ratio , albuminuria , medicine , type 2 diabetes , endocrinology , renin–angiotensin system , cancer , proportional hazards model , triglyceride , diabetes mellitus , cholesterol , oncology , confidence interval , blood pressure
Background In type 2 diabetes (T2D), copresence of low‐density lipoprotein cholesterol (LDL‐C) <2.8 mmol/L with triglyceride <1.7 mmol/L or with albuminuria synergistically increased cancer risk. We tested whether use of renin angiotensin system inhibitors attenuated the increased cancer risk associated with these two risk subphenotypes. Methods A prospective cohort of 4307 patients with T2D enrolled from December 1996 to January 2005 was analysed using a new user cohort design. Cox model analysis was used to obtain hazard ratios and 95% confidence intervals. The study measured additive interactions between nonuse of renin angiotensin system inhibitors and low LDL‐C plus low triglyceride or albuminuria for the risk of cancer. A positive interaction suggests a specific drug effect on the low LDL‐C‐related cancer risk. Results During 18 769 person years of follow‐up (median follow‐up years: 4.44), 4.48% ( n = 193) of patients developed cancer. Use of renin angiotensin system inhibitors was associated with reduced cancer risk among patients with copresence of low LDL‐C plus low triglyceride or low LDL‐C plus albuminuria but not in patients without these subphenotypes. In multivariable analysis, renin angiotensin system inhibitor usage attenuated the hazard ratio of copresence of low LDL‐C plus low triglyceride versus lack of this subphenotype for cancer from 2.08 (95% CI: 1.25–3.47) to 1.13 (0.61–2.11) with significant additive interaction ( p = 0.0225). Similarly, RAS inhibitor usage attenuated the hazard ratio of copresence of low LDL‐C plus albuminuria versus lack of this subphenotype for cancer from 1.99 (95% CI: 1.12–3.56) to 0.82 (0.43–1.54) with significant additive interaction ( p = 0.0009). Conclusion In T2D, renin angiotensin system inhibitor usage may specifically attenuate the low LDL‐C‐related cancer risk. Copyright © 2013 John Wiley & Sons, Ltd.