Use of beta‐blockers, angiotensin‐converting enzyme inhibitors and angiotensin receptor blockers and breast cancer survival: Systematic review and meta‐analysis

Breast cancer (BC) is the second leading cause of cancer death among women in Western Countries. Beta‐blocker (BB) drugs, angiotensin‐converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) were suggested to have a favorable role in the development and progression of BC. We have performed a meta‐analysis to clarify the potential benefits of these drugs on BC survival. A total number of 46 265 BC patients from eleven papers were included, ten independent studies on BB use and seven on ACEi/ARB use. The summary hazard ratio (SHR) was estimated by pooling the study‐specific estimates with random effects models and maximum likelihood estimation. We assessed the homogeneity of the effects across studies and evaluated between‐study heterogeneity by meta‐regression and sensitivity analyses. We found a significant improvement in BC specific survival for patients treated with BB drugs at the time of BC diagnosis (SHR: 0.44; 95%CI: 0.26–0.73 with I2 = 78%). We also observed a borderline significant improvement in disease free survival for subjects treated with BB (SHR: 0.71, 95%CI: 0.19–1.03). No association of ACEi/ARB use with disease free and overall survival was found. In conclusion, we report epidemiological evidence that BB improve BC‐specific survival. Clinical trials addressing this hypothesis are warranted.

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