Renin–angiotensin system inhibitor use and colorectal cancer risk and mortality: A dose–response meta analysis

Abstract

Objective: This study was undertaken to determine whether use of the renin–angiotensin system (RAS) inhibitors would increase colorectal cancer morbidity and mortality. Methods: Databases were electronically searched to collect data of RAS use and colorectal cancer morbidity and mortality from inception to October 2018. Stata 12.0 software was used to perform a meta-analysis. Results: A total of 16 publications involving 2,847,597 participants were included. RAS inhibitor use was related to colorectal cancer risk (relative risk (RR): 0.86; 95% confidence interval (CI): 0.78–0.93) and mortality (RR: 0.80; 95% CI: 0.66–0.98) decrement. Subgroup analysis showed angiotensin-converting enzyme inhibitor (ACEI)/angiotensin II receptor blocker (ARB) (RR: 0.82; 95% CI: 0.69-0.96) or ARB (RR: 0.86; 95% CI: 0.73–0.98) or ACEI (RR: 0.81; 95% CI: 0.70–0.92) were related to colorectal cancer risk decrement. Furthermore, RAS inhibitor use was related to colorectal cancer risk decrement in Caucasians (RR: 0.88; 95% CI: 0.80–0.96) and Asians (RR: 0.72; 95% CI: 0.61–0.85). Additionally, dose–response showed that per one year duration of RAS inhibitor use incremental increase was related to 6% colorectal cancer risk decrement (RR: 0.94; 95% CI: 0.90–0.97). Conclusion: According to the evidence, RAS inhibitor use was associated with colorectal cancer risk and mortality decrement.