rpcardioRational Pharmacotherapy in CardiologyРациональная Фармакотерапия в Кардиологии1819-64462225-3653«SILICEA-POLIGRAF» LLC10.20996/1819-6446-2018-14-6-887-890rpcardio-1803Research ArticlePAGES OF RUSSIAN NATIONAL SOCIETY OF EVIDENCE-BASED PHARMACOTHERAPYСТРАНИЦЫ НАЦИОНАЛЬНОГО ОБЩЕСТВА ДОКАЗАТЕЛЬНОЙ ФАРМАКОТЕРАПИИAngiotensin Converting Enzyme Inhibitors and the Risk of Lung Cancer – New Scientific Evidences or Another Example of “Pseudo-Evidence” Medicine?Ингибиторы ангиотензинпревращающего фермента и риск развития рака легких – новые научные данные или очередной пример «псевдодоказательной» медицины?МарцевичС. Ю.MartsevichS. Yu.

д.м.н., профессор, руководитель отдела профилактической фармакотерапии

MD, PhD, Professor, Head of Department of Preventive Pharmacotherapy

sergeymartsevich@mail.ruНациональный медицинский исследовательский центр профилактической медициныРоссияNational Medical Research Center for Preventive MedicineRussian Federation201804012019146887890Copyright © Martsevich S.Y., 20192019Марцевич С.Ю.Martsevich S.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.rpcardio.online/jour/article/view/1803

The quality of the database analysis that led to the conclusion that angiotensin converting enzyme inhibitors contribute to the development of lung cancer is analyzed. The author notes that the analysis of the potential risk from taking these drugs is possible only if it is related to the proven positive effect of these drugs on the prognosis of life in certain categories of patients, primarily with chronic heart failure and a history of acute myocardial infarction. Attention is drawn to the methodological errors of the study, putting the main conclusion of the analysis into question.

В статье оценивается качество анализа базы данных, приведшего к выводу о том, что ингибиторы ангиотензинпревращающего фермента способствуют развитию рака легких. Отмечается, что анализ потенциального риска от приема этих препаратов возможен только при соотнесении его с доказанным положительным влиянием этих препаратов на прогноз жизни у определенных категорий больных, в первую очередь, страдающих хронической сердечной недостаточностью и перенесших острый инфаркт миокарда. Обращается внимание на методические погрешности исследования, ставящие основной вывод анализа под сомнение.

ингибиторы ангиотензинпревращающего ферментариск развития рака легкихсравнение наблюдательных и рандомизированных исследованийсоотношение польза/рискangiotensin converting enzyme inhibitorslung cancer riskthe comparing of observational and randomized studiesrisk/benefit ratioReferencesAvorn J. Two Centuries of Assessing Drug Risks. New Engl J Med. 2012;367;3:193-7. doi:10.1056/NEJMp1206652.Avorn J. Two Centuries of Assessing Drug Risks. New Engl J Med. 2012;367;3:193-7. doi:10.1056/NEJMp1206652.Barter P.J., Caulfield M., Eriksson M. et al. ILLUMINATE Investigators. Effects of torcetrapib in patients at high risk for coronary events. N Engl J Med. 2007;357(21):2109-22. doi:10.1056/NEJMoa 0706628.Barter P.J., Caulfield M., Eriksson M. et al. ILLUMINATE Investigators. Effects of torcetrapib in patients at high risk for coronary events. N Engl J Med. 2007;357(21):2109-22. doi:10.1056/NEJMoa 0706628.ISPE. Guidelines for good pharmacoepidemiology practices (GPP). Pharmacoepidemiology and Drug Safety. 2008;17:200-8. doi:10.1002/pds.1471.ISPE. Guidelines for good pharmacoepidemiology practices (GPP). Pharmacoepidemiology and Drug Safety. 2008;17:200-8. doi:10.1002/pds.1471.CONSENSUS Trial Study Group. Effects of enalapril on mortality in severe congestive heart failure. Results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS). N Engl J Med. 1987;316(23):1429-35. doi:10.1056/NEJM198706043162301.CONSENSUS Trial Study Group. Effects of enalapril on mortality in severe congestive heart failure. Results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS). N Engl J Med. 1987;316(23):1429-35. doi:10.1056/NEJM198706043162301.Zannad F., Anker S.D., Byra W.M. et al. COMMANDER HF Investigators. Rivaroxaban in Patients with Heart Failure, Sinus Rhythm, and Coronary Disease. N Engl J Med. 2018;379(14):1332-42. doi:10.1056/NEJMoa1808848.Zannad F., Anker S.D., Byra W.M. et al. COMMANDER HF Investigators. Rivaroxaban in Patients with Heart Failure, Sinus Rhythm, and Coronary Disease. N Engl J Med. 2018;379(14):1332-42. doi:10.1056/NEJMoa1808848.Марцевич С.Ю., Навасардян А.Р., Захарова Н.А., Лукьянов М.М. Новые оральные антикогулянты: можно ли результаты международных контролируемых исследований с этими препаратами переносить на российских больных? Кардиоваскулярная Терапия и Профилактика. 2015;14(5):48-52Martsevich S.Yu., Navasardyan A.R., Zakharova N.A., Lukyanov M.M. New oral anticoagulants: can the results of international controlled studies with these drugs be transferred to Russian patients? Cardiovascular Therapy and Prevention. 2015;14(5):48-52 (In Russ.)PROGRESS Collaborative Group. Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6105 individuals with previous stroke or transient ischaemic attack. Lancet. 2001;358(9287):1033-41. doi:10.1016/S0140-6736(01)06178-5.PROGRESS Collaborative Group. Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6105 individuals with previous stroke or transient ischaemic attack. Lancet. 2001;358(9287):1033-41. doi:10.1016/S0140-6736(01)06178-5.The Heart Outcomes Prevention Evaluation Study Investigators. Effects of an angiotensin-convertingenzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med. 2000;342:145-53. doi:10.1056/NEJM200001203420301.The Heart Outcomes Prevention Evaluation Study Investigators. Effects of an angiotensin-convertingenzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med. 2000;342:145-53. doi:10.1056/NEJM200001203420301.Beckett N.S., Peters R., Fletcher A.E. et al. HYVET Study Group.Treatment of hypertension in patients 80 years of age or older. N Engl J Med. 2008;358(18):1887-98. doi:10.1056/NEJMoa0801369.Beckett N.S., Peters R., Fletcher A.E. et al. HYVET Study Group.Treatment of hypertension in patients 80 years of age or older. N Engl J Med. 2008;358(18):1887-98. doi:10.1056/NEJMoa0801369.Pfeffer M.A., Braunwald E., Moye L.A. et al. for the SAVE Investigators. Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction and myocardial infarction: results of the Survival and Ventricular Enlargement Trial. N Engl J Med. 1992;327:669-77. doi:10.1056 / NEJM199209033271001.Pfeffer M.A., Braunwald E., Moye L.A. et al. for the SAVE Investigators. Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction and myocardial infarction: results of the Survival and Ventricular Enlargement Trial. N Engl J Med. 1992;327:669-77. doi:10.1056 / NEJM199209033271001.Savarese G., Costanzo P., Cleland J. et al. A meta-analysis reporting effects of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in patients without heart failure. J Am Coll Cardiol. 2013;61:131-42. doi:10.1016/j.jacc.2012.10.011.Savarese G., Costanzo P., Cleland J. et al. A meta-analysis reporting effects of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in patients without heart failure. J Am Coll Cardiol. 2013;61:131-42. doi:10.1016/j.jacc.2012.10.011.Hicks M.B., Filion K.B., Yin H. et al. Angiotensin converting enzyme inhibitors and risk of lung cancer: population based cohort study. BMJ. 2018;363:k4209. doi:10.1136/bmj.k4209.Hicks M.B., Filion K.B., Yin H. et al. Angiotensin converting enzyme inhibitors and risk of lung cancer: population based cohort study. BMJ. 2018;363:k4209. doi:10.1136/bmj.k4209.Ингибиторы АПФ могут повысить риск возникновения рака. Новости медицины. Российский Медицинский Журнал. [цитировано 20.11.2018]. Доступно на: https://www.rmj.ru/news/ingibitory-apf-mogut-povysit-risk-vozniknoveniya-raka/ACE inhibitors can increase the risk of cancer. Medicine news. Russian Medical Journal. [cited by Nov 20, 2018]. Available at: https://www.rmj.ru/news/ingibitory-apf-mogut-povysit-risk-vozniknoveniya-raka/. [Ингибиторы АПФ могут повысить риск возникновения рака. Новости медицины. Российский Медицинский Журнал. [цитировано 20.11.2018]. Доступно на: https://www.rmj.ru/news/ingibitory-apf-mogut-povysit-risk-vozniknoveniya-raka/].Ford E.S., Ajani U.A., Croft J.B., et al. Explaining the decrease in U.S. deaths from coronary disease, 1980-2000. N Engl J Med. 2007;356:2388-98. doi:10.1056/NEJMsa053935.Ford E.S., Ajani U.A., Croft J.B., et al. Explaining the decrease in U.S. deaths from coronary disease, 1980-2000. N Engl J Med. 2007;356:2388-98. doi:10.1056/NEJMsa053935.Cronin-Fenton D. Angiotensin converting enzyme inhibitors and lung cancer. Any extra risk must be balanced against the mortality benefits of ACE use. BMJ. 2018;363:k4337. doi:10.1136/bmj. k4337.Cronin-Fenton D. Angiotensin converting enzyme inhibitors and lung cancer. Any extra risk must be balanced against the mortality benefits of ACE use. BMJ. 2018;363:k4337. doi:10.1136/bmj. k4337.Gliklich R.E., Dreyer N.A., Leavy M.B. eds. Registries for Evaluating Patient Outcomes: A User’s Guide. 3rd ed. Rockville (MD): Agency for Healthcare Research and Quality (US); 2014Gliklich R.E., Dreyer N.A., Leavy M.B. eds. Registries for Evaluating Patient Outcomes: A User’s Guide. 3rd ed. Rockville (MD): Agency for Healthcare Research and Quality (US); 2014Danaei G., Tavakkoli M., Herman M.A. Bias in observational studies of prevalent users: lessons for comparative effectiveness research from a meta-analysis of statins. Am J Epidemiol. 2012;175:250-62. doi:10.1093/aje/kwr301.Danaei G., Tavakkoli M., Herman M.A. Bias in observational studies of prevalent users: lessons for comparative effectiveness research from a meta-analysis of statins. Am J Epidemiol. 2012;175:250-62. doi:10.1093/aje/kwr301.Center for drug evaluation and research. Application number: 207620Orig1s000. MEDICAL REVIEW(S) [cited by Nov 20, 2018]. Available at: https://www.accessdata.fda.gov/ drugsatfda_docs/nda/2015/207620Orig1s000MedR.pdf.Center for drug evaluation and research. Application number: 207620Orig1s000. MEDICAL REVIEW(S) [cited by Nov 20, 2018]. Available at: https://www.accessdata.fda.gov/ drugsatfda_docs/nda/2015/207620Orig1s000MedR.pdf.Sipahi I., Debanne S.M., Rowland D.Y. et al. Angiotensin-receptor blockade and risk of cancer: metaanalysis of randomised controlled trials. Lancet Oncol. 2010;11(7):627-36. doi:10.1016/S1470-2045(10)70106-6.Sipahi I., Debanne S.M., Rowland D.Y. et al. Angiotensin-receptor blockade and risk of cancer: metaanalysis of randomised controlled trials. Lancet Oncol. 2010;11(7):627-36. doi:10.1016/S1470-2045(10)70106-6.D’Agostino R.B. Tutorial in biostatistics propensity score methods for bias reduction in the comparison of a treatment to а non-randomized control group. Statist Med. 1998;17:2265-81.D’Agostino R.B. Tutorial in biostatistics propensity score methods for bias reduction in the comparison of a treatment to а non-randomized control group. Statist Med. 1998;17:2265-81.

The authors declare that there are no conflicts of interest present.