Angiotensin Receptor Blockers and Risk of Prostate Cancer Among United States Veterans

Authors

  • Gowtham A. Rao MD, PhD, MPH,

    Corresponding author
    1. William J.B. Dorn Veterans Affairs Medical Center, Columbia, South Carolina, USA
    2. School of Public Health, University of South Carolina, USA
    3. Cancer Prevention and Control Program, Columbia, South Carolina, USA
    • University of South Carolina, Columbia, South Carolina, USA
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  • Joshua R. Mann MD, MPH,

    1. University of South Carolina, Columbia, South Carolina, USA
    2. School of Public Health, University of South Carolina, USA
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  • Matteo Bottai ScD,

    1. School of Public Health, University of South Carolina, USA
    2. Karolinska Institutet, Solna, Sweden
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  • Hiroji Uemura MD, PhD,

    1. Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
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  • James B. Burch MS, PhD,

    1. William J.B. Dorn Veterans Affairs Medical Center, Columbia, South Carolina, USA
    2. School of Public Health, University of South Carolina, USA
    3. Cancer Prevention and Control Program, Columbia, South Carolina, USA
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  • Charles Lee Bennett MD, PhD, MPP,

    1. South Carolina College of Pharmacy, Columbia, South Carolina, USA
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  • Kathlyn Sue Haddock PhD, RN,

    1. William J.B. Dorn Veterans Affairs Medical Center, Columbia, South Carolina, USA
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  • James R. Hébert ScD

    1. School of Public Health, University of South Carolina, USA
    2. Cancer Prevention and Control Program, Columbia, South Carolina, USA
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  • This manuscript was the result of PhD dissertation project of Dr. Gowtham A. Rao. The dissertation committee was chaired by Dr. James R. Hébert.

Corresponding Author:

Gowtham A. Rao, MD, PhD, MPH, Department of Family and Preventive Medicine, School of Medicine, University of South Carolina, 3209 Colonial Drive, Columbia, SC 29203, USA

Email: gowtham.rao@va.gov

Abstract

To address concerns regarding increased risk of prostate cancer (PrCA) among angiotensin receptor blocker (ARB) users, we used national retrospective data from the Department of Veterans Affairs (VA) through the Veterans Affairs Informatics and Computing Infrastructure. We identified a total of 543,824 unique Veterans who were classified into either ARB treated or not-treated in 1:15 ratio. The two groups were balanced using inverse probability of treatment weights. A double-robust cox-proportional hazards model was used to estimate the hazard ratio for PrCA incidence. To evaluate for a potential Gleason score stage migration, we conducted weighted Cochrane-Armitage test. Post weighting, the rates of PrCA in treated and not-treated groups were 506 (1.5%) and 8,269 (1.6%), respectively; representing a hazard ratio of (0.91, p-value .049). There was no significant difference in Gleason scores between the two groups. We found a small, but statistically significant, reduction in the incidence of clinically detected PrCA among patients assigned to receive ARB with no countervailing effect on degree of differentiation (as indicated by Gleason score). Findings from this study support Food and Drug Administration's recent conclusion that ARB use does not increase risk of incident PrCA.

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