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June 13th, 2010
06:36 PM ET
Blood pressure drugs may raise cancer risk, study findsBy Miriam Falco Certain blood pressure medications may be linked to a modestly increased risk of cancer, according to a study published in the British medical journal The Lancet Oncology on Sunday. However, researchers cannot say the exact risk of cancer for each of these drugs, so they are calling for more research. Some leading cancer and heart experts don't necessarily agree with the conclusions of this study. The drugs in question are called angiotensin-receptor blockers or ARBs. ARBs block the chemical angiotensin II from having any effect on the heart and blood vessels, thus preventing blood pressure from going up. These drugs are commonly prescribed to patients with high blood pressure, heart failure and diabetes-related kidney disease. Researchers at The University Hospitals Case Medical Center in Cleveland, Ohio, reviewed nine existing studies involving ARBs. "We were able to compile data of more than 60,000 patients," says lead study author Dr. Ilke Sipahi. Sipahi, a heart failure expert, tells CNN that he and a few colleagues decided to analyze the published data about this class of drugs because several studies from the past few years suggested an increased cancer risk, and millions of people in the United States and around the world are taking these drugs. He says their analysis found a 1.2 percent increased cancer risk for patients taking these drugs over four years. Sipahi says the current data suggest an "overall 10 percent increase in the risk of cancer diagnosis in patients on ARBs compared to placebo." The study also concludes that the risk for lung cancer was the highest. However, the study authors could not explain why these drugs might be causing cancer. In an accompanying editorial, Dr. Steven Nissen, chairman of the Department of Cardiovascular Medicine at the Cleveland Clinic (which is not associated with UH Case Medical Center), suggests the results of this analysis require "urgent regulatory review." Dr. Nicholas Vogelzang, an expert on several cancers and spokesman for the American Society of Clinical Oncology disagrees. He says he's fairly skeptical about the study conclusion because the only statistically significant rise was in lung cancer and "there's no direct mechanism to lung cancer should go up, but breast cancer went down. He adds that most cancers take 40 years to develop. "ARBs were not even on the market before 1995," says Vogelzang. "This gives me some pause." The American Cancer Society's Dr. Michael Thun raises the same concern. "If the drugs caused this, then the increased cancer risk appeared much more quickly than is usually the case for solid tumors." The American Heart Association's President Dr. Clyde Yancy actually takes ARBs to control his high blood pressure. He tells CNN in a statement, "These data raise a question, and a question only, regarding ARBs and the risk of cancer. Only non-small cell lung cancer was statistically increased and the extent of the increase was quite modest. We usually describe these kinds of findings as a 'signal' but given the modest result, perhaps this is more of a 'hint.'" Yancy says the results of this study do not change anything for him – he will continue to take his blood-pressure lowering ARB. Study author Sipahi says he will continue to prescribe ARBs because for many patients the risk of dying from heart failure outweighs the possible risk of cancer development. All the experts CNN spoke with recommend patients stay on their medications and talk to their doctor if they have any concerns. CNN requested comment from several manufacturers of ARBs. Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.
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Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.
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QUOTE:
"If the drugs caused this, then the increased cancer risk appeared much more quickly than is usually the case for solid tumors."
And so he concludes the report is wrong? Did it even occur to him that a rapid increase in cancers could mean that these drugs cause very aggressive, fast-growing cancers?
Instead of dismissing this study, they should be wanting to do much more research, but, no, they want to ignore it because it goes against establishment dogma.
Jim Purdy
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It would be helpful....... if they noted which blood pressure pills...... they used in testing
Article on cancer drugs. What was the total population, ages, P value,R squared and drugs tested, at a minimum. Totally irresponsible as most data stories today. Let us decide. How to lie with statistics is an old book. People who forward data from outside sources need to read it.
How many of these people who were taking the medication and developed lung cancer were also smokers?
To Al ODonnell,
You can link to the original article in the Lancet with the numbers, p values, etc. This story was summarizing a meta-analysis, actually a good way to look at studies, from the original article ...
" Patients randomly assigned to receive ARBs had a significantly increased risk of new cancer occurrence compared with patients in control groups (7·2% vs 6·0%, risk ratio [RR] 1·08, 95% CI 1·01—1·15; p=0·016). When analysis was limited to trials where cancer was a prespecified endpoint, the RR was 1·11 (95% CI 1·04—1·18, p=0·001). Among specific solid organ cancers examined, only new lung-cancer occurrence was significantly higher in patients randomly assigned to receive ARBs than in those assigned to receive control (0·9% vs 0·7%, RR 1·25, 1·05—1·49; p=0·01). No statistically significant difference in cancer deaths was observed (1·8% vs 1·6%, RR 1·07, 0·97—1·18; p=0·183)."
Certainly doesn't look like more agressive tumors Mr. Purdy, if there was no difference in cancer deaths. I bet the ARBs have some minimal effect on tumors that were already there, so they appear to "Cause" the tumors... but that is just my 2 cents.
MH
Would it kill ya to tell the names of these drugs? 🙁
(Quoting the late great comedian George Carlin):
"The Surgeon General has determined that saliva causes stomach cancer.
However, only when swallowed in small amounts,
over a long period of time".
(Quoting comedian Lewis Black):
"Health researchers don't know what the f**k they're doing!"
For example, are eggs good or bad for you?"
*dead silence*
"I rest my case".
Hmm... I wonder whether the study considered the drug(s) that the patients were on before being switched to ARBs, or if they were taking ARBs in addition to other anti-hypertensives. Most hypertensive individuals are normally on a combination therapy, anyway.
It doesn't really pass the common sense test. That this single class of drugs, over a period of 4 years, caused an 1.2% increase in the incidence of non-small cell lung cancer but decreased the incidence of other solid tumors would be very unusual behavior for a carcinogen. Meta-analysis are a often usual statistical tool but just as often the results must be closely scrutinized.
It may turn out to be an interesting study, but I have profound doubts that it will lead the FDA to do anything about it that the drug companies don't want them to do.
Of course Nissen is involved; he thinks every drug is unsafe.
The name of the drugs PLEASE!!!
The one drug you mention by name is from the one company that responded to your inquiries? Leaves us in the dark, and next time . . . probably you . . .
What about this other study that suggests beta-blocker (blood pressure) medicine actually reduces the spread of cancer??
http://news.bbc.co.uk/2/hi/health/8589066.stm
It seems that none of them really know what they're doing.
Since these drugs dilate blood vessels, it makes me wonder if they are contributing to more quick growth of tumors through increasing their vasculature, rather than causing new tumors. That would certainly explain the relatively short period of time where the "hint" may be seen.
To Jimbo:
ACE Inhibitors include common drugs such as lisinopril, enalapril, ramipril, quinapril, and captopril.
ARBs include losartan (cozaar/hyzaae), olmesartan (Benicar), telmisartan (micardis), valsartan (diovan), and irbesartan (Avapro).
Also, I'd take this study with a grain of salt. I haven't read it yet, but who knows if they controlled cigarette smoking as a confounding variable. Also, many people who smoke also tend to have higher rates of cardiovascular disease, and they also tend to have higher rates of cancer. I would NOT d/c blood pressure medication (these are great drugs BTW) because of a very small increase risk in lung cancer, especially if you don't have a family history or don't smoke.
Source:
Pharmacist
JImbo – I found a list at this URL:
http://www.medicinenet.com/angiotensin_ii_receptor_blockers/page2.htm
I love it when layman try to interpret "scientific papers" written by "science" journalists!
Jimbo: These are drugs like Losartan/ Valsartan (Cozaar, Hyzaar, Diovan etc)
who cares? no one is going to get out of this world alive anyway! WE ALL DIE! Some sooner than others.
One of the best post ever.
This is exactly the type of headline that the public is exposed to and then everyone runs to change effective medication. To quote one of the "experts" this is maybe a "hint" of a problem.
I agree with Matt`s comment above "of course if Nissan is involved, every drug is unsafe".
Silly nonsence.......they didn't tell you that reading this stuff on your computer causes eyeball cancer?????.......enough of this!!!!!! You're gonna die from something.......
Very interesting. My dad had to heart attacks in 2000, after being on Plavix, and other HBP medicines.He developed very aggressive lung cancer in 2007 and 6 months later he died.
Quite an amazing journalistic decision - to omit the names of the drugs (or at least some of them) in the study. Does the writer of this piece assume that all her readers know which blood pressure meds are included in the ARB category?
A 10% increase is not insignificant. At least Dr Yancy will make a case study of himself, though, tragically, his hypertensive patients, as well.
I have been taking blood pressure meds for over 15 years. Maybe that is what caused my Prostate Cancer.I dislike taking all meds but sometimes you have to gamble. Spend a fortune or die.Damned if you do or damned if you don't. Life is a gamble.
Great....I'm darned if I do, and darned if I don't. 😛
Let me get this right?
1. The people have been used as lab rats for 4 years and NOW these results come out?!
2. Why isn't the FDA on this like white on rice? They're quick to tell us SPECIFICALLY what nutraceutical products are no good us, yet, these pharmaceutical drugs that were APPROVED by the FDA are still being used by countless people across this country!!
3. WHY doesn't this article mention SPECIFICALLY the pharmaceutical drugs in question? WHY are their names still protected?
Nissen thinks every drug is unsafe UNLESS they are padding his pocket to speak for them at lectures.
Dr. William Li, in one of the TED talks, talked about angiogenesis and how the growth and perpetuation of blood vessels actually feeds cancer/tumors- when anti-angiogenic meds are used to shut down those extra blood vessels, tumors stop growing and often disappear. Perhaps the angiogenic nature of ARBs is behind the small increase in cancer among those that use them.
Will current or future drugs have negative side effects? Absolutely. That's why people need to know their family history and current metabolic profile, then try to minimize disease risk making the best educated choice. We are doing nothing short than trying to intervene medically to differ our genetic and epigenetic outcomes – of course there are risks!!!
The only caveat is that when we make an educated choice, we hope that we are educated properly about the risks of the drugs that we about to take....
Jimbo-
The ARB drugs are: Cozaar, Diovan, Avapro, Benicar, Micardis, and Teveten. I think that is all of them, but there could be more.
I've had the best luck dropping blood pressure by getting the grain out of my diet (corn, more specifically, and that takes some serious vigilance because corn is in just about everything and has lots of different names that you can find lists for on the web if you search for corn allergens), and exercise. I also seem to need salt to take away fluid. It's not what they tell you, but quite frankly I haven't found much of what they told me to be true. Everyone is different, and I know that. (I could tell a difference in about three days. I lost the classic diabetic symptom...frequent urination in small amounts...stopped in three days. Blood pressure went to perfect normal. But it sort of makes sense when you think about it. I had to go back to food that isn't processed to get away from it. Make your own soup out of real vegetables. Stay out of the middle of the store. Shop the veggie counter.) Exercise really does a lot also. It doesn't take long for it to show up. Not sure if it would work for everyone. I worked for me.
I would rather find out why its high and do something about it than take a drug. (Not sure that works for everyone though.)
I don't trust them anymore. I think I've just decided that I'm on my own now. Not going back. If I die, I die. Better than going through that mess.
Have never seen one physician/celebrity make a bigger name for himself than crying wolf like Steve Nissen.
Ignore those frightening alerts or warnings
From time to time we heard so much about such things,and almost every month's occuring make ordinary people ponders and panic.
Is there a conspiracy between the doctors and the pharmacutical drugs manufactuers company to promote new or old drugs.
The wolve is not coming!
These drugs (ARBs, angiotensin receptor blockers) are often given to patients who first take other drugs and develop a cough while on the earlier medication. This analysis showed a modest increase in cancers and only statistically significant in non-small cell lung cancers. Cough can also be a symptom of lung cancer. Some non-small cell lung cancers are relatively slow growing. It could be that the patients' symptom of cough was not a side effect of their earlier drug, not identified as a symptom of a growing cancer, and the patient was changed to an ARB. If the cough improves even a little, the patient would stay on the ARB, the cough would be attributed to the first medication, and the cough would be considered as resolved or improved. If it were possible, the immediate follow-up analysis of this data would be to compare the number of patients in the cancer and non-cancer groups who were changed to an ARB due to cough. The take-home message from the study may turn out to be: "If a smoking patient develops a cough on a hypertension medication, first be certain that something else is not causing the cough before blaming the drug."
I do not work for any drug company.
I am calling my doctor to take me off of Atacand immediately (for hypertension)! So many of these greedy drug companies do not properly vet or study these new drugs before releasing them to market. This is highly immoral and reprehensible. In essence, we are all guinea pigs for them. Look at Vioxx and Bextra. Be very very scared people. Demand the FDA has more 'teeth' and impartial board members!
To M. Harris
Thanks for keeping it real by providing the stats! It is amazing the distortions and manipulations in science! Unfortunately for the lay person, there is no way of knowing this as it takes years for us to learn stats. Even given the stats you provided, I would want to see research methods, sample demographics, etc before buying into anything here.
And the double whammy: this is about medications and so the industry must continue to protect itself. We will see nothing more here, despite the fact that millions have BP issues.
I take Amlodipine 20mg and Lisinopril 20mg. Any concerns with these two meds I should be worried about? I meen I felt fine until I read this artical as I have been taking these drugs for years. When my high blood pressure was first diagnosed I was taking Altace 20mg that worked good but was to expensive for an out of pocket patient like myself. 2 months ago I decided to change my eating habits and have dropped some weight. my blood pressure has returned to normal and my Dr. lowered the dosage of the Amlodipine to 10mg so my goal is to get off these meds altogether and live a heathier life. I had sevreal family members who died from cancer so my concern runs deep. I guess my real question would be how long from taking these drugs does it take before I am at high risk for developing Cancer?
Has anyone ever considered not smoking or drinking and maybe eating healthier (no fast food) and even exercising once in a while?
Just a thought.
I am wondering about any comment or safety issue regarding other ACE inhibitors like Lisinopril. As the target of both the drugs are similar (to block excess AngII production by inhibiting ACE) but the mode of action is different, I am curious to know from Dr Nissen or Dr Sipahi about their comments.
A commenter below suggested that the pro-angiogensis quality of ARB medications may be responsible for an increase in cancer incidence. I would ask where this commenter got their information. It is clear that there is some discrepancy in the literature regarding this idea as there are a few articles which specifically state that ARBs act via various signal transduction cascades to promote anti-angiogenesis and anti-proliferative properties. One such example is here:
http://www.ncbi.nlm.nih.gov/pubmed/16101380
Antiproliferative efficacy of angiotensin II receptor blockers in prostate cancer.
Abstract
An apparent low prevalence of cancer in hypertensive patients receiving angiotensin converting enzyme inhibitors is reported; however, the molecular mechanisms have not been elucidated. Angiotensin-II (Ang-II) is well known to be associated with hypertension, as a main peptide of the renin-angiotensin system, and its detailed molecular mechanisms have recently been elucidated. For instance, Ang-II directly activates the mitogenic signal transduction pathway through the angiotensin-II type-1 (AT1) receptor in smooth muscle cells and cardiac myocytes. Ang-II receptor blockers (ARBs), a class of antihypertensive agent, suppress signal transduction pathways mediated by growth factors such as epidermal growth factor (EGF), through the AT1 receptor. Our studies demonstrated that an ARB had the potential for antiproliferative effects and inhibition of angiogenesis in prostate cancer cells. The AT1 receptor is categorized in the guanosine phosphate binding protein-coupled receptors (GPCRs), which are viewed as critical regulators of the interactions between epithelial and stromal cells. Hence, we consider that in overcoming prostate cancer, it is very important to inhibit GPCR signaling in cancer cells by ARBs. It is unclear how prostate cancer growth changes from being hormone dependent to independent, and no effective therapy has therefore been developed. Our clinical data revealed that ARB administration decreased prostate specific antigen (PSA) and improved performance status in patients with hormone-refractory prostate cancer. This review provides an insight into the key role of Ang-II and the possibility of ARBs for molecular targeting of mitogenesis and angiogenesis in prostate cancer.
While this above article and the cited studies suggest that this potential issue may be a problem, it needs to be further explored before any conclusion is reached. I would not advocate staying on or going off the medication in a general sweeping recommendation, but rather, I would sit down with my doctor, review my history and discuss the potential benefits and harms from continuing with ARB therapy and with the help of my doctor, make the most informed decision.
For the past 5 years, I've been taking Micardis (Telmisartan) for high blood pressure. This medication is manufactured by the pharmaceutical company Boehringer Ingelheim mentioned at the end of the article. Two years ago I was diagnosed with non-Hodgkin's Lymphoma (T-cell Lymphoma). Prior to having this cancer, I had no other illnesses/diseases. My Oncologist told me they cannot pinpoint the cause. I wasn't even part of any of the high risk groups. I don't know if taking Micardis for 5 years raised my risk of developing the lymphoma, but it sure made me lose some sleep last night after reading this article. I'll wait for further development on this. By the way, during the time my doctor was working on long-term treatment for my hypertension, he placed me on a medication (can't recall the name) to reduce my massive headaches. Less than two weeks later, I asked him to take me off of it because I was having tremblors similar to patients with Parkinsons. At the time, that medication was being peddled by the manufacturer for "off the label use" for pain. It was intended as a prescription med for seizures, however with several side effects including the trembling. Within a year (around 2004) that company was fined by the FDA and paid multi-million dollars for its misdeeds. I am curious to find out if any of the pharm companies have been aware of the risks related to ARBs.
The fact is that hypertension and obesity are linked, and that obesity increases the risk of cancer. Just because the patient's taking the antihypertensives have a body habitus increasing their risk of cancer does not necessarily mean that their antihypertensive drug is what is increasing their cancer risk. It is very doubtful that the drug has anything at all to do with the increased risk of cancer.
It is quite probable that an increased risk of cancer could be found with any antihypertensive drug, simply because the patient population is a self-selected group.
This article is a load of bunk , 4 years ago there was a similar metanalysis stating thats ARB's caused heart attacks and was then refutted bigtime , leading the author to recant. Most of these drugs have been out for over 10 years and the companies have huge safety databases of real life usage. which the FDA has access to. The FDA also has read all this information as each of the cited trials were published and their has been no signals for any of these drugs as mono therapy... I have 2 parents on Micardis and after reading how well this drug was researched, with a solid safety profile ...I am Glad my parents are covered by such effective drugs.
Metanalysis are soft and not credible from a clinical perspective, lumping studies together with totally different populations, locations background meds , ( I've actually read the article ) while ignoring large trials thart rufute their findings is iresponsible ..and from the number of people I have seen post here scared now of their effective medication, there should be some serious backlash to these authors , who by the sounds of it are looking for some fat money to do a baseless study...when the money could be better spent on cures for cancer vs smoke and mirror stats.
In relation to these new findings, ciould you advise about the HB drug "Tenoretic" – Thank you.
Steve Nissen is the most unscrupulous physician on the face of the earth. Yet again, he comes out against the lifesaving drugs that he prescribes every day. What a hypocrite ! He did the same thing with Vytorin, nearly causing Schering Plough to go under, which ultimately led to them being bought by Merck. The FDA subsequently rebuffed the Enhance Trial and said that Vytorin was effective, but that didnt get any of the media play that the original story did. Apparently Nissen is still jockeying to become head of the FDA, which thankfully didnt happen. His reputation amongst physicians like myself is completely ruined – he's a joke. No wonder his fellow cardiologists call him the "Crestor Whore" !
Dag nabbit good stuff you whipperpsanpers!
It appears that more research will be required on the specific sub population who acquire cancer from ARBs. Are they smokers or ex smokers? Are they more obese that those who don't develop cancer? Until we get a clearer map of those at risk for cancer, I would as a general precaution enhance my exercise program and nutrition program to reduce weight and also try to reduce the dosage of all BP medicines. The ARB I take is a $4 dollar per day pill, a "blockbuster" drug, which can lead to collusion between drug companies and MDs. And, don't kill the messenger, the alarmist Dr Nissen, after all, the data in their raw form do suggest an increase in cancer, and that is something all BP patients want to avoid.
My mother was on Diovan HCTZ and developed a pancreatic tumor that was termed "pre cancerous". There was no history of any cancer in our family with the exception of 1 prostate cancer. She died while hospitalized, after the surgery to remove the affected area of her pancreas. The death certificate states "pancreatic cancer" as the cause of death. I am on the same medication. Please push for more studies!!!!!!
That\'s not even 10 miuents well spent!