artigo em Ingles No Cancer Risk Elevation From ARBs: Two New Analyses_Sera?Steve StilesApril 13, 2011 (Copenhagen, Denmark) At odds with a controversial 2010 meta-analysis [1], two new reports--one on an observational cohort study [2] and the other a meta-analysis [3]--have concluded that treatment with an angiotensin-receptor blocker (ARB) does not increase the risk of cancer compared with non-ARB therapy.The new studies now make at least three that contest a June 2010 meta-analysis that shook the world of hypertension management by finding a "moderate" but significant 8% increased overall risk of incident cancers among ARB recipients vs comparators, which were usually placebo. The study from Dr Ilke Sipahi (University Hospitals Case Medical Center, Cleveland, OH) and colleagues, reported by heartwire , found in particular a significant 25% increase in risk of lung cancer. The report triggered an ARB safety review by the European Medicines Agency [4] and by the FDA [5], both of which remain ongoing.However, "We believe there is now strong evidence for an absence of association between ARB exposure and cancer," Dr Bjorn Pasternak (Statens Serum Institute, Copenhagen, Denmark), lead author of the new cohort study, wrote to heartwire in an email. "Collectively, the available data provide support for physicians to continue to prescribe ARBs without concern about an excess risk of cancer."His group's findings, published online April 11, 2011 in Circulation, were based on the public-health records of >300 000 people in Denmark. They showed no significant rise in risk of incident cancer or overall cancer mortality among those taking ARBs compared with others taking angiotensin-converting enzyme (ACE) inhibitors--independent of sex, type of ARB, and duration of ARB exposure.In a subgroup analysis, there was no ARB link to risk of lung cancer or any of a long list of other malignancies, except for male genital cancers, primarily of the prostate. But that finding "must be interpreted with caution, considering the possibility of a chance finding resulting from multiple comparisons," Pasternak et al write.The Danish-cohort findings were similar to those in the new meta-analysis, from the ARB Trialists Collaboration and published in the April 2011 issue of the Journal of Hypertension. It found no increased incidence of cancer for ARB recipients compared with control groups across 15 randomized trials encompassing almost 140 000 patients. Nor was the risk increased for specific types of cancer, including lung cancer, or for individual ARBs or for the combination of an ARB and ACE inhibitor.A Happy End to the Story? The new reports corroborate a November 2010 meta-analysis that saw no increased cancer risk from ARB therapy across 70 clinical trials and almost 325 000 patients. They "basically reassure us again that the risk of cancer cannot be documented in such a short period of time," said the November report's senior author, Dr Franz Messerli (St Luke Presbyterian Hospital, New York), to heartwire ."The Sipahi paper was a very weak paper to start with. The cancer risk [in it] was minimal. We do not have any distinct pathophysiologic mechanism that would explain a cancer risk. So I would say the Sipahi paper has been completely