This post comes to us from Jeffrey Anderson, M.D., F.A.C.C., chair-elect of the ACC/American Heart Association Task Force on Practice Guidelines and Vice Chair of the 2010 UA/NSTEMI Focused Update. Dr. Anderson also is the Associate Chief of Cardiology at Intermountain Medical Center in Murray, UT.

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Angiotensin-receptor blocker (ARB) agents drugs have shown substantial reductions in the risk of cardiovascular mortality, myocardial infarction and stroke in patients with hypertension and heart disease. However, a recent article in Lancet Oncology that looks at a pooled analysis of studies focused on the cardiovascular effects of ARBS, suggests these drugs may modestly increase the risk of a new cancer diagnosis. It should be noted that the absolute risk is small, the study is retrospective and exploratory, and that the question of class effect versus specific drug effect for the potential cancer risk is uncertain.

The article, while not definitive, has generated a good deal of discussion within the cardiovascular community about how best to react in terms of both further study and in discussing with patients.

As with any product used in the care of patients with cardiovascular disease, the ACC is a huge proponent of understanding both the product’s effectiveness and safety. In this particular case, the College is supportive of efforts to further clarify the association of ARBs and cancer and put the study’s potential findings into better perspective. For example, do the proven benefits of ARBs outweigh the risk of cancer? That being said, these new data should not warrant overreaction.

In the interim, patients should not stop taking ARBs based upon these data, but should work with their care providers to determine the best medication regimen. (If you're looking for a good article to give your patients on the topic, see this CardioSmart article.) The study does not diminish the importance of treating hypertension or left ventricular systolic dysfunction with effective regiments prescribed by their physicians, which may include the use of ARBs. Current UA/NSTEMI and STEMI guidelines, as well as performance measures for heart failure at AMI, remain current in that they generally support ACE inhibitors as first-line therapy where appropriate. ARBs are recommended for patients who cannot tolerate ACE inhibitors. 

What do you think?

- Jeffrey Anderson, M.D., F.A.C.C.