OBJECTIVES: This analysis aims to reproduce a UK based study, by investigating whether there is a risk between angiotensin converting enzymes (ACEIs) and lung cancer among a cohort of US patients, using a real world approach.

METHODS: Real world data, composed of electronic medical records from approximately 53.4 million U.S. patients were analyzed. The index event was defined as initiation of either ACEIs or angiotensin receptor blockers (ARBs), anytime on or after January 1^st 2000. Medications were defined using RxNorm codes. Patients who had lung cancer prior to the initiation of ACEIs or ARBs were excluded from the analysis, as well as those who had ever had any other cancers in order to rule out secondary lung cancers. The ICD-10 code C34 was used to define the primary outcome, lung cancer, with an observation period between 1 day to anytime after medication initiation. Risk ratios (RR) were calculated and propensity score matching used to balance cohorts and adjust for 110 of the most likely confounders. Propensity scores matched 1:1 using a nearest neighbor greedy matching algorithm with a caliper of 0.25 times the standard deviation.

RESULTS: In the balanced cohort of 189,444 patients, use of ACEIs, compared with ARBs was associated with an increased risk for lung cancer, RR 1.17 (p=0.0479).

CONCLUSIONS: In this real world analysis of a cohort of U.S. patients, the use of ACEIs was associated with an increased risk for lung cancer, in comparison with use of ARBs. Further analyses of this cohort could include analyzing risk over different time periods.