scholarly journals Angiotensin Receptor 1 Blockers Prolong Time to Recurrence after Radiofrequency Ablation in Hepatocellular Carcinoma patients: A Retrospective Study

Biomedicines ◽  
2020 ◽  
Vol 8 (10) ◽  
pp. 399 ◽  
Author(s):  
Antonio Facciorusso ◽  
Mohamed A. Abd El Aziz ◽  
Ivan Cincione ◽  
Ugo Vittorio Cea ◽  
Alessandro Germini ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Radiofrequency Ablation ◽  
Enzyme Inhibitors ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Converting Enzyme Inhibitors ◽  
Time To Recurrence ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Inhibition of angiotensin II synthesis seems to decrease hepatocellular carcinoma recurrence after radical therapies; however, data on the adjuvant role of angiotensin II receptor 1 blockers (sartans) are still lacking. Aim of the study was to evaluate whether sartans delay time to recurrence and prolong overall survival in hepatocellular carcinoma patients after radiofrequency ablation. Data on 215 patients were reviewed. The study population was classified into three groups: 113 (52.5%) patients who received neither angiotensin-converting enzyme inhibitors nor sartans (group 1), 59 (27.4%) patients treated with angiotensin-converting enzyme inhibitors (group 2) and 43 (20.1%) patients treated with sartans (group 3). Survival outcomes were analyzed using Kaplan–Meier analysis and compared with log-rank test. In the whole study population, 85.6% of patients were in Child-Pugh A-class and 89.6% in Barcelona Clinic Liver Cancer A stage. Median maximum tumor diameter was 30 mm (10–40 mm) and alpha-fetoprotein was 25 (1.1–2100) IU/mL. No differences in baseline characteristics among the three groups were reported. Median overall survival was 48 months (42–51) in group 1, 51 months (42–88) in group 2, and 63 months (51–84) in group 3 (p = 0.15). Child-Pugh stage and Model for End-staging Liver Disease (MELD) score resulted as significant predictors of overall survival in multivariate analysis. Median time to recurrence was 33 months (24–35) in group 1, 41 (23–72) in group 2 and 51 months (42–88) in group 3 (p = 0.001). Number of nodules and anti-angiotensin treatment were confirmed as significant predictors of time to recurrence in multivariate analysis. Sartans significantly improved time to recurrence after radiofrequency ablation in hepatocellular carcinoma patients but did not improve overall survival.

scholarly journals Positive association of angiotensin II receptor blockers, not angiotensin-converting enzyme inhibitors, with an increased vulnerability to SARS-CoV-2 infection in patients hospitalized for suspected COVID-19 pneumonia

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0244349
Author(s):  
Jean-Louis Georges ◽  
Floriane Gilles ◽  
Hélène Cochet ◽  
Alisson Bertrand ◽  
Marie De Tournemire ◽  
...  
Keyword(s):  
Angiotensin Converting Enzyme ◽  
Enzyme Inhibitors ◽  
Previous Treatment ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Converting Enzyme ◽  
Angiotensin Ii Receptor ◽  
Converting Enzyme Inhibitors ◽  
Receptor Blockers ◽  
Group 2 ◽  
Group 1

Background Angiotensin-converting enzyme 2 is the receptor that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) uses for entry into lung cells. Because ACE-2 may be modulated by angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs), there is concern that patients treated with ACEIs and ARBs are at higher risk of coronavirus disease 2019 (COVID-19) pneumonia. Aim This study sought to analyze the association of COVID-19 pneumonia with previous treatment with ACEIs and ARBs. Materials and methods We retrospectively reviewed 684 consecutive patients hospitalized for suspected COVID-19 pneumonia and tested by polymerase chain reaction assay. Patients were split into two groups, according to whether (group 1, n = 484) or not (group 2, n = 250) COVID-19 was confirmed. Multivariable adjusted comparisons included a propensity score analysis. Results The mean age was 63.6 ± 18.7 years, and 302 patients (44%) were female. Hypertension was present in 42.6% and 38.4% of patients in groups 1 and 2, respectively (P = 0.28). Treatment with ARBs was more frequent in group 1 than group 2 (20.7% vs. 12.0%, respectively; odds ratio [OR] 1.92, 95% confidence interval [CI] 1.23–2.98; P = 0.004). No difference was found for treatment with ACEIs (12.7% vs. 15.7%, respectively; OR 0.81, 95% CI 0.52–1.26; P = 0.35). Propensity score-matched multivariable logistic regression confirmed a significant association between COVID-19 and previous treatment with ARBs (adjusted OR 2.36, 95% CI 1.38–4.04; P = 0.002). Significant interaction between ARBs and ACEIs for the risk of COVID-19 was observed in patients aged > 60 years, women, and hypertensive patients. Conclusions This study suggests that ACEIs and ARBs are not similarly associated with COVID-19. In this retrospective series, patients with COVID-19 pneumonia more frequently had previous treatment with ARBs compared with patients without COVID-19.

Pharmacokinetic interaction between cefdinir and two angiotensin-converting enzyme inhibitors in rats.

1996 ◽  
Vol 40 (4) ◽  
pp. 979-982 ◽  
Author(s):  
A Jacolot ◽  
M Tod ◽  
O Petitjean
Keyword(s):  
Angiotensin Converting Enzyme ◽  
Enzyme Inhibitors ◽  
Enzyme Inhibitor ◽  
Pharmacokinetic Interaction ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Converting Enzyme ◽  
Time Curve ◽  
Converting Enzyme Inhibitors ◽  
Group 2 ◽  
Group 1

The pharmacokinetic interaction between cefdinir and an angiotensin-converting enzyme inhibitor (captopril or quinapril) was investigated in rats. The linearity of cefdinir pharmacokinetics was demonstrated in three groups of rats receiving 10, 20, or 40 mg of cefdinir per kg of body weight intravenously. Then, three other groups of rats were established as follows: group 1 (n = 5) received cefdinir (10 mg/kg) intravenously, and 12 blood samples per rat were drawn between 0 and 8 h after injection of the dose; group 2 (n = 5) was treated in the same way as group 1, but captopril (0.8 mg/kg) was coadministered by intraintestinal injection into all animals; group 3 (n = 6) was treated in the same way as group 2, but quinapril (0.8 mg/kg) replaced captopril. Plasma cefdinir concentrations were measured by liquid chromatography, and the data were analyzed by a noncompartmental method. Finally, three groups of four or five rats each were set up as described above, but the cefdinir dose was 20 mg/kg and the animals were sacrificed 1 h after drug injection to collect blood to determine the unbound cefdinir fraction (fu) by ultrafiltration. The angiotensin-converting enzyme inhibitors increased the mean cefdinir area under the concentration-time curve up to 8 h by a factor of 1.8 (captopril; P < 0.05) and a factor of 3.5 (quinapril; P < 0.05). With captopril, mean cefdinir clearance was decreased by a factor of 2, and the volume of distribution increased by the same factor, while the fu increased from 15.4% +/- 3.0% (cefdinir alone) to 22.8% +/- 10.9% (cefdinir plus captopril). Captopril increased the cefdinir half-life from 0.62 +/- 0.17 to 2.92 +/- 0.95 h. With quinapril, the interaction was so strong that no elimination phase was detectable in four of the six rats, and therefore, no pharmacokinetic parameter values other than the cefdinir fu could be calculated; the cefdinir fu increased to 25.1% +/- 11.1%. It is concluded that captopril and quinapril (and/or their metabolites) have a major impact on the disposition of cefdinir in rats, probably by competition at the plasma protein-binding level and at the tubular anionic carrier level. This latter mechanism should also be relevant in humans.

Abstract 4633: Pretreatment with Mineralcorticoid Receptor Antagonists Plus Beta Blockers and Angiotensin Converting Enzyme Inhibitors Increases the Proportion of Patients in Sinus Rhythm after Electrical Cardioversion for Persistent Atrial Fibrillation and Heart Failure

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Gabriello Marchetti ◽  
Renzo Roncuzzi ◽  
Stefano Urbinati ◽  
Daniela Vivoli ◽  
Alberto Barbieri ◽  
...  
Keyword(s):  
Heart Failure ◽  
Angiotensin Converting Enzyme ◽  
Sinus Rhythm ◽  
Enzyme Inhibitors ◽  
Beta Blockers ◽  
Persistent Atrial Fibrillation ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Converting Enzyme Inhibitors ◽  
Group 2 ◽  
Group 1

Aim of this study was to assess the effect on sinus rhythm maintenance after electrical cardioversion of pre-treatment with mineralcorticoid receptor antagonist (MRA) added to beta blockers (BB) and angiotensin-converting enzyme inhibitors (ACEI) in patients with heart failure and persistent atrial fibrillation. We studied 168 consecutive patients with left ventricular dysfunction and persistent atrial fibrillation (AF) who underwent electrical cardioversion (ECV) in our Day Hospital.Group 1 (83 pts) was pretreated with MRA plus BB and ACEI and group 2 (85 pts) with only BB and ACEI. Mean age was 74.4 years in group 1 and 73.9 years in group 2; male gender was 70% in group 1 and 72% in group 2 ; estimated onset of arrhythmia was 5 + −2 months in two groups; ischemic heart disease was present in 55% of group 1 and 61% in group 2 .Hypertension was present in 70% of group 1 and 61% in group 2. Echocardio-graphic parameters of left atrial diameter were not statistically different in two groups:44 mm versus 47 mm ; ejection fraction was 46% (group 1) and 44% (group 2).All patients received warfarin during the 1 year follow up. Aldosterone antagonists ( plus BB and ACEI ) was continued in group 1 after ECV. Group 2 received treatment with BB and ACEI. 4 pts in group 1 and 6 pts in group 2 showed early re-initiation of AF after cardioversion and a second ECV was successfully repeated. At 1 year follow up 67% of pts of group 1 remained in sinus rhythm compared with 42% of pts not treated with aldosterone antagonists. The results in our investigation regarding the proportion of pts in sinus rhythm after ECV favour this treatment strategy for patients with persistent AF and heart failure. A possible mechanism of this result is that aldosterone too stimulates collagen production leading to atrial fibrosis. Remodeling process in heart failure can be better antagonized by combined treatment of Beta blockers, Angiotensin Converting-Enzyme inhibitors and Mineralcorticoid receptors Antagonists.

scholarly journals Antihypertensive therapy features in multimorbid outpatients

2021 ◽  
Vol 26 (6) ◽  
pp. 688-698
Author(s):  
N. V. Izmozherova ◽  
A. A. Popov ◽  
V. M. Bakhtin ◽  
M. A. Shambatov
Keyword(s):  
Antihypertensive Therapy ◽  
Enzyme Inhibitors ◽  
Antihypertensive Drugs ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Cross Sectional Study ◽  
Charlson Index ◽  
Converting Enzyme Inhibitors ◽  
Cross Sectional ◽  
Group 2 ◽  
Group 1

Objective. To assess the characteristics of antihypertensive therapy (AHT) in outpatient patients in relation to comorbidities and multimorbidity level. Design and methods. A cross-sectional study included 140 patients with diagnosed hypertension (HTN). We performed a standardized complaints and medical history registration, questionnaire survey, anthropometry, office blood pressure (BP) assessment. Based on Charlson index the patients were divided into 2 groups: group 1 with moderate multimorbidity (≤ 4 points), group 2 with high multimorbidity level (≥ 5 points). The data are presented as median and proportions with bi-directional 95 % confidence interval. Results. In the sampling of 100 (64,3 71,4 78,6 %) women and 40 (21,4 28,6 35,7 %) men median age was 65 68 70, median Charlson index was 4 5 5. Group with moderate multimorbidity included 63 patients. High multimorbidity group included 77 subjects. HTN degree did not differ between the groups. Subjects from group 2 had higher level of cardiovascular risk (χ2 = 17,2, df = 2, p = 0,00018) and were more likely to have a history of HTN-associated clinical conditions (χ2 = 27,1, df = 2, p = 0,00000). By the time of examination, AHT was started in 137 (95,097,9 100,0%) patients. Monotherapy was ongoing in 20 cases (8,814,3 20,4%), combined AHT was prescribed to 117 (79,6 85,4 91,2 %) persons: 50 (21,2 36,5 43,8 %) patients received 2 drugs, 67 (40,9 48,9 56,9 %) patients received ≥ drugs. Number of antihypertensive drugs was higher in patients of group 2 than in group 1 (χ2 = 6,7, df = 2, p = 0,036). Drug number was not associated with HTN degree (χ2 = 3,8, df = 4, p = 0,44). Patients from group 2 were more likely to take β1-blockers (p = 0,027) and moxonidine (p = 0,042). Non-steroid anti-inflammatory drugs (NSAIDs) reduced the frequency of achieving the target BP level in patients treated by angiotensin converting enzyme inhibitors (p = 0,002). The frequency of achieving target BP was 42,9 50,7 58,6 %, it was independent of the number of prescribed drugs (p = 0,07) and did not differ in the groups of moderate and high multimorbidity (p = 0,87). Conclusions. Multimorbid patients require combined antihypertensive drugs to control hypertension. Multimorbidity level, comorbidities and drug-to-drug interactions should be taken into account during individualized HTN management. NSAID significantly affect the effectiveness of antihypertensive therapy.

scholarly journals Complex treatment of hepatocellular carcinoma at early (BCLC-A) and intermediate (BCLC-B) stages

2020 ◽  
Vol 25 (2) ◽  
pp. 55-66
Author(s):  
B. N. Kotiv ◽  
I. I. Dzidzava ◽  
S. A. Alent’yev ◽  
A. V. Smorodsky ◽  
K. I. Makhmudov ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Targeted Therapy ◽  
Radiofrequency Ablation ◽  
Liver Resection ◽  
Transarterial Chemoembolization ◽  
Survival Rates ◽  
Locoregional Therapy ◽  
Group 2 ◽  
Group 1

Аim. Evaluation of the effectiveness of hepatocellular carcinoma treatment at early BCLC-A and intermediate BCLC-B stages by the combined use of liver resections and locoregional therapy.Materials and methods. The study included 142 patients with hepatocellular carcinoma. At the BCLC-A stage – 46 observations, at the BCLC-B stage – 96 observations. Chronic hepatitis and cirrhosis of various etiologies were detected in 58 (40.8%) patients. Liver resection of various volumes, transarterial chemoembolization and radiofrequency ablation were used for treatment. With the tumor progression and the ineffectiveness of locoregional therapy, targeted therapy was prescribed.Results. Four groups of patients were identified depending on treatment tactics. In group 1, 28 patients underwent radical liver resections; in group 2, 37 patients underwent preoperative transarterial chemoembolization and liver resection. In group 3, 63 patients underwent therapeutic transarterial chemoembolization and radiofrequency ablation. In group 4, 14 patients underwent transarterial chemoembolization followed by hepatic arterial infusion of chemotherapy and targeted therapy. Overall survival in groups 1 and 2 significantly exceeds survival rates in groups 3 and 4. The median overall survival in groups 1–4 was 39, 37.5, 19.5, and 7.5 months (p1–3 = 0.0001 ; p1–4 = 0.0009, p2–3 = 0.018 , p 2–4 = 0.001). The cumulative one, three and five year survival rates in groups 1 and 2 did not significantly differ (87.8% and 80.0%, 82.5% and 75.0%, 68.2% and 58.0%, 54.5% and 41.0%, respectively, p1–2 = 0.076). However, group 1 consisted exclusively of patients with BCLC-A stages with solitary tumors less than 6.5 cm in diameter, group 2 included large BCLC-A tumors and multiple tumors BCLC-B stages (67.6%).Conclusion. For the treatment of patients with hepatocellular carcinoma BCLC-A and BCLC-B stages, a multimodal approach should be applied, including differential use and a rational combination of regional chemotherapy and resection techniques, taking into account the functional state of the liver.

Importance of subset classification based on tumor size for patients with single hepatocellular carcinoma.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 373-373
Author(s):  
Jian-Hong Zhong ◽  
Bang-De Xiang ◽  
Liang Ma ◽  
Yan-Yan Wang ◽  
Ning-Fu Peng ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Tumor Size ◽  
Staging System ◽  
Cancer Staging ◽  
Group 4 ◽  
Group 3 ◽  
Group 2 ◽  
Similar Survival ◽  
Group 1

373 Background: Single hepatocellular carcinoma (HCC) regardless of size that without vascular invasion is classified as stage A disease in the Barcelona Clinic Liver Cancer staging system. However, patients with different tumor size may have different overall survival after hepatectomy. This study compared the prognosis of patients with single HCC after hepatectomy among groups with different tumor size. Methods: Patients with newly diagnosed single HCC from January 1, 2004 to October 31, 2013 were classified according to tumor size: group 1, ≤ 5 cm; group 2, > 5 cm and ≤ 8 cm; group 3, > 8 cm and < 10 cm; and group 4, ≥ 10 cm. Overall survival analysis was performed according to tumor size. Results: A total of 857 patients were enrolled. Among them, 814 (95.0%) were with Child-Pugh A class liver function. Blood loss was 367 ± 424 mL. Groups 1, 2, 3, and 4 consisted of 426 (49.7%), 229 (26.7%), 52 (6.1%), and 150 (17.5%) patients, respectively. The 5 years overall survival ranged from 35 to 63% in all four groups. The median survival time differed significantly according to tumor size (76, 49, 43, and 38 months in groups 1, 2, 3, and 4, respectively; P  <  0.001). Group 3 had overall similar survival to group 4. Multivariate analysis showed that group 3 and 4 had significantly worse overall survival compared to group 1 and 2. Conclusions: Patients in group 3 and 4 had significant worse prognosis than those in group 1 or group 2. Our results suggest that subset classification based on tumor size is warranted to patients’ prognosis.

scholarly journals Effects of Antihypertensive Drugs Use on Risk and Prognosis of Colorectal Cancer: A Meta-Analysis of 37 Observational Studies

2022 ◽  
Vol 12 ◽  
Author(s):  
Yujiao Deng ◽  
Yuxiu Xie ◽  
Meng Wang ◽  
Peng Xu ◽  
Bajin Wei ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Enzyme Inhibitors ◽  
Antihypertensive Drugs ◽  
Progression Free Survival ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Angiotensin Ii Receptor ◽  
Converting Enzyme Inhibitors ◽  
Free Survival ◽  
Receptor Blockers

Background: Antihypertensive drugs might play a key role in the risk and poor prognosis of colorectal cancer. However, current epidemiologic evidence remains inconsistent. The aim of this study is to quantify the association between antihypertensive drugs and colorectal cancer.Methods: To identify available studies, we systematically searched electronic databases: PubMed, Web of Science, Embase, Cochrane Library. The risk estimates and their corresponding 95% confidence intervals (CIs) were collected and analyzed by using random-effects models. Heterogeneity test and sensitivity analysis were also performed.Results: Overall, 37 observational studies were included in this analysis (26 studies with cohort design, three studies with nested case-control design, and 8 studies with case-control design). Antihypertensive drugs did not present a significant effect on the risk or overall survival of patients with colorectal cancer [Risk ratio (RR) = 1.00, 95% CI: 0.95–1.04; Hazard ratio (HR) = 0.93, 95% CI: 0.84–1.02]. In the subgroup analysis, diuretics use was significantly associated with a worse overall survival of patients with colorectal cancer (HR = 1.27; 95% CI: 1.14–1.40). However, use of angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers was associated with improved progression-free survival of patients who suffered from colorectal cancer (HR = 0.83; 95% CI: 0.72–0.95).Conclusion: Antihypertensive drug usage did not influence the risk and overall survival of patients with colorectal cancer in general. Further investigation reminded us that diuretics use might reduce the overall survival time in colorectal cancer patients, whereas those who took Angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers had a longer progression-free survival.

scholarly journals Novel Value of Preoperative Gamma-Glutamyltransferase Levels in the Prognosis of AFP-Negative Hepatocellular Carcinoma

2020 ◽  
Vol 2020 ◽  
pp. 1-11
Author(s):  
Liang-He Lu ◽  
Wei-Wei ◽  
Anna Kan ◽  
Jie-Mei ◽  
Yi-Hong Ling ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Multivariable Analysis ◽  
Tumor Development ◽  
Disease Free Survival ◽  
Tumor Burden ◽  
Optimal Cutoff ◽  
Gamma Glutamyltransferase ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Background. Gamma-glutamyltransferase (GGT) is involved in tumor development and progression, but its prognostic value in α-fetoprotein- (AFP-) negative (AFP<25 ng/mL) hepatocellular carcinoma (HCC) patients remains unknown. Methods. A large cohort of 678 patients with AFP-negative HCC following curative resection who had complete data were enrolled in this study. The optimal cutoff value for the preoperative level of GGT was determined by the X-tile program. Independent prognostic factors for overall survival (OS) and disease-free survival (DFS) were also identified. Results. The optimal cutoff values for the preoperative levels of GGT were 37.2 U/L and 102.8 U/L, which were used to divide all patients into three subgroups (group 1, GGT<37.2 U/L (n=211, 31.1%); group 2, GGT≥37.2 and <102.8 U/L (n=320, 47.2%); group 3, GGT≥102.8 U/L (n=147, 21.7%)), with distinct OS times (58.5 vs. 53.5 vs. 44.4 months, P<0.001) and DFS times (47.9 vs. 40.3 vs. 30.1 months, P<0.001). Elevated preoperative GGT levels were associated with an unfavorable tumor burden (larger tumor size, multiple tumors, and microvascular invasion) and were selected as independent predictors of a worse OS (group 2 vs. group 1, HR: 1.73 (1.13-2.65), P=0.011; group 3 vs. group 1, HR: 3.28 (2.10-5.13), P<0.001) and DFS (group 2 vs. group 1, HR: 1.52 (1.13-2.05), P=0.006; group 3 vs. group 1, HR: 2.11 (1.49-2.98), P<0.001) in multivariable analysis. Conclusions. Elevated preoperative GGT levels are associated with an unfavorable tumor burden and serve as an independent prognostic marker for worse outcomes in AFP-negative HCC patients following resection.

scholarly journals Impact of Metabolic Syndrome Diagnosis and Its Treatment on Survival of Colorectal Cancer Patients

2019 ◽  
Vol 2019 ◽  
pp. 1-9 ◽  
Author(s):  
Rose N. Mafiana ◽  
Maimona S. Al-Kindi ◽  
Ngozichukwu Mafiana ◽  
Ahmed S. Al Lawati ◽  
Mansour Al Moundhri
Keyword(s):  
Colorectal Cancer ◽  
Metabolic Syndrome ◽  
Overall Survival ◽  
Enzyme Inhibitors ◽  
Antihypertensive Drugs ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Hypoglycemic Agents ◽  
Arab Population ◽  
Converting Enzyme Inhibitors ◽  
Sultan Qaboos University

Background. Epidemiologic findings on the effect of metabolic syndrome (MetS) and its treatment on colorectal cancer (CRC) survival have been inconsistent and have not been previously studied in an Arab population such as the Omani population.Patients and Methods. Data from the hospital records of 301 CRC patients treated in Sultan Qaboos University (SQUH), Oman, from 2006 to 2014 were analyzed retrospectively to determine the effects of MetS and its treatment on CRC survival. Overall survival (OS) by MetS status and by medications for MetS components management was compared with Cox proportional models.Results. Of the 301 patients, 76 (25.2%) had MetS, 20.3% were on insulin, 23.9% were on metformin, 25.6% took statins, 17.9% were on either angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blocker (ARB). Whereas metformin (HR, 0.46, 95% CI, 0.25-0.84) and statins (HR, 0.58; 95% CI, 0.35-0.96) had a protective effect on OS, insulin (HR 1.73, 95% CI, 1.02-2.97) had a detrimental effect. In subgroup analysis of diabetic subjects, a nonsignificant improvement in OS was observed in the metformin treated patients compared to those on other hypoglycemic agents (HR, 0.92, 95% CI, 0.55-1.55). Neither MetS nor antihypertensive drugs had any apparent effect on OS.Conclusions. Our result suggests that, among CRC patients with MetS, taking metformin and statins may improve overall survival, whereas being on insulin may negatively impact CRC prognosis. Further studies are warranted to determine the exact mechanism through which metformin, statins, and insulin exert their effects on CRC survival.

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