Association between ACE inhibitors and acute pancreatitis in the elderly

Background: Angiotensin-converting enzyme (ACE) inhibitor-induced acute pancreatitis has been described in various case reports and drug surveillance databases. At present, no epidemiologic studies examining the potential association between ACE inhibitors and acute pancreatitis have been identified. Objective: To determine whether there is an association between ACE inhibitor use and pancreatic events (acute pancreatitis, pancreatic surgery). Methods: A retrospective cohort of Ontario residents aged greater than or equal to66 years was created using population-based administrative databases from January 1, 1994, through March 31, 2000. We compared the incidence of pancreatic events among new users of ACE inhibitors (study group), warfarin (null baseline group), and dihydropyridine calcium-channel antagonists (DCCAs; disease control group) using multivariate Cox proportional hazard models. Outcome Measures: The primary outcome measure was hospitalization with acute pancreatitis; the secondary outcome measure was incidence of pancreatic surgery. Results: For acute pancreatitis, the crude incidence rates per 10 000 person-years were 9.0 for the ACE inhibitor group (n=174824); 7.1 for the DCCA group (n=73719), and 7.6 for the warfarin group (n=40057). Relative to warfarin users, neither ACE inhibitor users (adjusted rate ratio [aRR]=1.35; 95% CI 0.94 to 1.93) nor DCCA users (aRR=1.09; 95% CI 0.72 to 1.62) were at significantly higher risk of hospitalization for acute pancreatitis. For pancreatic surgery in the same population, the crude incidence rates per 10 000 person-years were 10.5 for the ACE inhibitor group, 10.6 for the DCCA group, and 10.7 for the warfarin group. Relative to subjects taking warfarin, neither ACE inhibitor users (aRR=1.09; 95% CI 0.80 to 4.49) nor DCCA users (aRR=1.11; 95% CI 0.79 to 1.56) were at significantly higher risk for pancreatic surgery. Conclusions: The use of ACE inhibitors does not appear to be associated with significant risk of acute pancreatitis among the elderly.