The Iranian Journal of Obstetrics, Gynecology and Infertility

The Iranian Journal of Obstetrics, Gynecology and Infertility

Effect of renin-angiotensin system inhibitors on survival rate of patients with breast cancer: systematic review and meta-analysis

Document Type : Review Article

Authors
Niloufar Naghibzadeh 1
Fereshteh Asgharzadeh 2
Majid Khazaei 3
1 M.Sc. student of Medical Physiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
2 PhD Student, Department of Medical Physiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
3 Professor, Department of Medical Physiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
10.22038/ijogi.2020.16884
Abstract
Introduction: Breast cancer is one of the most common cancers and the second leading cause of cancer deaths among women worldwide. There is direct relationship between hypertension and the risk of blood cancer. Since the studies have showed that renin-Angiotensin pathway can be involved in cancer progression, therefore, this study was performed with aim to investigate the effect of angiotensin-converting enzyme inhibitors (ACEI) on survival of breast cancer patients by meta-analysis method.
Methods: In this systematic review and meta-analysis, the databases of pubmed, scopus, and web of science were systematically searched with the keywords of Breast cancer, neoplasm, tumor, Angiotensin receptor blockers, Angiotensin converting enzyme inhibitors and survival using OR and AND without a time limit until February 19, 2020. I2 index was used to assess the heterogeneity between the studies. Egger's test was used for assessment of publication bias. Data were analyzed by meta-analysis method using random effects model.
Results: In this study, a total of 57708 papers were reviewed and 13 studies were included in this meta-analysis. The results of meta-Analysis showed that based on the random effects model, ACEI had no effect on the survival of patients with breast cancer (HR = 0.1; 95% CI: 12.1 to 0.89; p = 0.99).
Conclusion: The results of the studies show that using angiotensin receptor blocker and renin-angiotensin system inhibitors had no effect on survival of patients with breast cancer.
Keywords
Angiotensin converting enzyme inhibitors
Angiotensin receptor antagonist
Breast cancer
  1. Perdomo-Pantoja A, Mejía-Pérez SI, Gómez-Flores-Ramos L, Lara-Velazquez M, Orillac C, Gómez-Amador JL, et al. Renin angiotensin system and its role in biomarkers and treatment in gliomas. J Neurooncol 2018; 138(1):1-15.
  2. Hussain M, Awan FR. Hypertension regulating angiotensin peptides in the pathobiology of cardiovascular disease. Clin Exp Hypertens 2018; 40(4):344-352.
  3. Tahergorabi Z, Khazaei M. The relationship between inflammatory markers, angiogenesis, and obesity. ARYA Atheroscler 2013; 9(4):247-253.
  4. Datzmann T, Fuchs S, Andree D, Hohenstein B, Schmitt J, Schindler C. Systematic review and meta-analysis of randomised controlled clinical trial evidence refutes relationship between pharmacotherapy with angiotensin-receptor blockers and an increased risk of cancer. Eur J Intern Med 2019; 64:1-9.
  5. Lever AF, Hole DJ, Gillis CR, McCallum IR, McInnes GT, MacKinnon PL, et al. Do inhibitors of angiotensin-I-converting enzyme protect against risk of cancer? Lancet 1998; 352(9123):179-84.
  6. Anastasiadi Z, Lianos GD, Ignatiadou E, Harissis HV, Mitsis M. Breast cancer in young women: an overview. Updates Surg 2017; 69(3):313-317.
  7. Phakathi B, Cubasch H, Nietz S, Dickens C, Dix-Peek T, Joffe M, et al. Clinico-pathological characteristics among South African women with breast cancer receiving anti-retroviral therapy for HIV. Breast 2019; 43:123-129.
  8. Bahrami A, Hassanian SM, Khazaei M, Hasanzadeh M, Shahidsales S, Maftouh M, et al. The Therapeutic Potential of Targeting Tumor Microenvironment in Breast Cancer: Rational Strategies and Recent Progress. J Cell Biochem 2018; 119(1):111-122.
  9. Tajbakhsh A, Hasanzadeh M, Rezaee M, Khedri M, Khazaei M, ShahidSales S, et al. Therapeutic potential of novel formulated forms of curcumin in the treatment of breast cancer by the targeting of cellular and physiological dysregulated pathways. J Cell Physiol 2018; 233(3):2183-2192.
  10. Hashemzehi M, Behnam-Rassouli R, Hassanian SM, Moradi-Binabaj M, Moradi-Marjaneh R, Rahmani F, et al. Phytosomal-curcumin antagonizes cell growth and migration, induced by thrombin through AMP-Kinase in breast cancer. J Cell Biochem 2018; 119(7):5996-6007.
  11. Nasiri N, Avan A, Hassanian SM, Khazaei M. Effect of anti-angiogenic drugs along with chemotherapy in breast cancer treatment: Review article. Iran J Obstet Gynecol Infertil 2019; 22(5): 78-89.
  12. Rojas K, Stuckey A. Breast Cancer Epidemiology and Risk Factors. Clin Obstet Gynecol 2016; 59(4):651-672.
  13. Hedges LV. Advances in statistical methods for meta-analysis. New directions for program evaluation 1984; 24:25-42.
  14. Bhaskaran K, Douglas I, Evans S, van Staa T, Smeeth L. Angiotensin receptor blockers and risk of cancer: cohort study among people receiving antihypertensive drugs in UK General Practice Research Database. BMJ 2012; 344:e2697.
  15. Fitzpatrick AL, Daling JR, Furberg CD, Kronmal RA, Weissfeld JL. Use of calcium channel blockers and breast carcinoma risk in postmenopausal women. Cancer 1997; 80(8):1438-1447.
  16. Huang CC, Chan WL, Chen YC, Chen TJ, Lin SJ, Chen JW, et al. Angiotensin II receptor blockers and risk of cancer in patients with systemic hypertension. Am J Cardiol 2011; 107(7):1028-33.
  17. Chae YK, Valsecchi ME, Kim J, Bianchi AL, Khemasuwan D, Desai A, et al. Reduced risk of breast cancer recurrence in patients using ACE inhibitors, ARBs, and/or statins. Cancer Invest 2011; 29(9):585-93.
  18. Sørensen GV, Ganz PA, Cole SW, Pedersen LA, Sørensen HT, Cronin-Fenton DP, et al. Use of β-blockers, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, and risk of breast cancer recurrence: a Danish nationwide prospective cohort study. J Clin Oncol 2013; 31(18):2265-72.
  19. Saltzman BS, Weiss NS, Sieh W, Fitzpatrick AL, McTiernan A, Daling JR, et al. Use of antihypertensive medications and breast cancer risk. Cancer Causes Control 2013; 24(2):365-71.
  20. Tascilar K, Azoulay L, Dell'Aniello S, Bartels DB, Suissa S. The Use of Telmisartan and the Incidence of Cancer. Am J Hypertens 2016; 29(12):1358-1365.
  21. Chen L, Chubak J, Boudreau DM, Barlow WE, Weiss NS, Li CI. Use of Antihypertensive Medications and Risk of Adverse Breast Cancer Outcomes in a SEER-Medicare Population. Cancer Epidemiol Biomarkers Prev 2017; 26(11):1603-1610.
  22. Boudreau DM, Yu O, Chubak J, Wirtz HS, Bowles EJ, Fujii M, et al. Comparative safety of cardiovascular medication use and breast cancer outcomes among women with early stage breast cancer. Breast Cancer Res Treat 2014; 144(2):405-16.
  23. Wang KL, Liu CJ, Chao TF, Huang CM, Wu CH, Chen TJ, et al. Long-term use of angiotensin II receptor blockers and risk of cancer: a population-based cohort analysis. Int J Cardiol 2013; 167(5):2162-6.
  24. Ganz PA, Habel LA, Weltzien EK, Caan BJ, Cole SW. Examining the influence of beta blockers and ACE inhibitors on the risk for breast cancer recurrence: results from the LACE cohort. Breast Cancer Res Treat 2011; 129(2):549-556.
  25. Holmes S, Griffith EJ, Musto G, Minuk GY. Antihypertensive medications and survival in patients with cancer: a population-based retrospective cohort study. Cancer Epidemiol 2013; 37(6):881-885.
The Iranian Journal of Obstetrics, Gynecology and Infertility
Volume 23, Issue 6
August 2020
Pages 88-96