Domenic A. Sica教授  美国弗吉尼亚大学

　　<International Circulation>: The relationship between angiotensin receptor blockers and cancer has attracted a lot of concern lately. The FDA has announced that ARBs do not increase the risk of cancer in it’s 2011 statement， but some studies have shown that patients who use ARBs do have an increased risk of cancer. Could you elaborate on your opinion on the relationship between ARBs and cancer risk?

　　Prof. Sica: Trying to define a relationship between ARBs and cancer risk requires enough power in the individual and collective studies to allow adequate assessment. When all studies are included， there appears to be really no risk relationship between ARBs and cancer. There is some data suggesting ARBs and ACE inhibitors given together may have a slightly increased risk but any risk relationship requires two other issues to be taken into account. One is biologic plausibility. The second is the time course of development of a malignancy. Often people are not exposed to a drug long enough for it to be biologically plausible for it to cause malignancy and we are simply unmasking an existing malignancy. The other item to consider is the duration of exposure. If it is lengthy enough， ACE inhibitors and probably ARBs keep people alive longer. Therefore， there is a greater duration of time over which you can uncover malignancy.

　　《国际循环》：近来血管紧张素受体阻断剂(ARBs)与癌症之间的关系备受关注。虽然FDA在其2011年声明中指出，ARBs并不增加癌症发生风险；但很多研究却表明应用ARBs的患者癌症发生风险增加。您能否谈一下能对ARBs与癌症风险关系的看法？

　　Sica教授：要想明确ARBs与癌症风险之间的关系，需要大量的具有效力的个体及集体研究对其进行充分的评估。对所有相关研究的分析显示，似乎ARBs与癌症之间真的没有相关性。有数据提示，ARBs与ACEI类药物联用可能会使癌症风险轻度增加。但这需要考虑以下两个问题，一个是生物学上的合理性，另一个是恶性肿瘤发生的时间过程。人们暴露在某种药物下的时间经常不足以使其发生生物学上导致恶性肿瘤的作用。我们目前只是简单地发现了现有的恶性肿瘤。另一个需要考虑的问题是药物的暴露时间。如果暴露时间足够长，ACEI以及ARBs能够使患者活得更长，因此，也就时我们有更多的时间来发现恶性肿瘤。