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Angiotensin inhibitors and receptor blockers linked to lower risk of nonmelanoma skin cancer

August 27, 2008

The use of angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) was associated with a reduced risk of basal cell or squamous cell skin cancers in U.S. veterans, researchers report in the August 26 online issue of the Journal of the National Cancer Institute.

ACE inhibitors and ARBs are frequently prescribed medications for the treatment of high blood pressure. Data from in vitro cell studies and animal models suggest these drugs may slow tumor growth and inhibit angiogenesis. Additionally, some epidemiological studies in humans suggest that ACE inhibitors and ARBs may reduce the risk of nonmelanoma skin cancers.

To test this possibility more specifically, Jennifer Christian, Pharm.D., Ph.D., of the VA Medical Center and Brown University in Providence, R.I., and colleagues performed a cohort study including 1,051 veterans who were at increased risk of keratinocyte skin cancers, including basal cell carcinoma or squamous cell carcinoma. The participants were already enrolled in a VA Cooperative Studies Program trial aimed at testing the efficacy of a topical agent. The researchers collected data on ACE inhibitor and ARBs use from a Veterans Affairs pharmacy database.

With a median follow-up of 3.4 years, the researchers identified 472 cases of basal cell carcinoma, 309 squamous cell cancers, and 200 deaths in the study population. The group taking either an ACE inhibitor or ARBs had a 39 percent relative reduction in incidence of basal cell cancer and a 33 percent relative reduction in squamous cell cancers compared with nonusers. The absolute incidence of the two cancers together was 237 per 1,000 person-years in the ACE inhibitor or ARB users and 374 per 1,000 among nonusers.

The researchers concluded that the use of these agents was associated with a reduction in the risk of nonmelanoma skin cancers but noted that the exact mechanism of action behind the reduction is unknown. "We were surprised to find such a pronounced reduction in [basal cell carcinoma and squamous cell carcinoma] incidence in users of ACE inhibitors or ARBs in such a high-risk group over a short amount of time," the authors write. "Because individuals at normal risk of keratinocyte cancer were not included in our study, the extent to which the results might apply to such individuals is unknown."

Journal of the National Cancer Institute