The Risk of Cardiovascular Disease in Prostate Cancer Patients Receiving Androgen Deprivation Therapies
The Risk of Cardiovascular Disease in Prostate Cancer Patients Receiving Androgen Deprivation Therapies
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DOI：
10.1097/ede.0000000000001132
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发表时间：
2020-05-01
期刊：
影响因子：
5.4
通讯作者：
McMenamin, Una C.
中科院分区：
文献类型：
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作者：
Cardwell, Chris R.;O'Sullivan, Joe M.;McMenamin, Una C.
背景：雄激素剥夺疗法(ADT)在前列腺癌治疗中的作用已被证实，它与多种心血管疾病有关。然而，很少有研究根据ADT的类型来研究这些相关性，特别是较新的ADT，如促性腺激素释放激素(GnRH)拮抗剂Destarelix。我们在现实环境中按ADT的类型调查了心血管疾病的风险。方法：我们从苏格兰癌症登记中心和全国ADT信息系统中确定了2009至2015年间新诊断为前列腺癌的男性。心血管事件是基于住院(来自医院记录)或心血管疾病死亡(来自死亡记录)。我们使用COX回归计算时变ADT暴露的心血管事件的危险比(HR)和95%可信区间(CI)，比较使用ADT的患者和未经治疗的患者，在调整了潜在的混杂因素(包括既往心血管疾病)后。结果：队列中包括20,216名前列腺癌患者，随访73,570人年，其间有3,853例心血管事件。ADT与心血管事件增加30%相关(调整后的HR=1.3；95%CI=1.2，1.4)。这反映了与GnRH激动剂(调整后的HR=1.3；95%CI=1.2，1.4)、地卡鲁胺(调整后的HR=1.5；95%CI=1.2，1.9)相关的心血管事件的增加，但与比卡鲁胺单药治疗(调整后的HR=1.0；95%CI=0.82，1.3)无关。结论：使用GnRH激动剂和去甲肾上腺素增加了心血管疾病的风险，但与比卡鲁胺单独治疗无关。这是第一个观察到去甲氧西林增加心血管风险的研究，但这种联系的原因尚不清楚，值得进一步研究。
Background:Androgen deprivation therapy (ADT), with a proven role in prostate cancer management, has been associated with various cardiovascular diseases. However, few studies have investigated these associations by type of ADT, particularly for newer ADTs such as the gonadotropin-releasing hormone (GnRH) antagonist degarelix. We investigated the risk of cardiovascular disease by type of ADT in a real-world setting.Methods:We identified men newly diagnosed with prostate cancer, from 2009 to 2015, from the Scottish Cancer Registry and ADTs from the nationwide Prescribing Information System. Cardiovascular events were based upon hospitalization (from hospital records) or death from cardiovascular disease (from death records). We used Cox regression to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for cardiovascular events with time-varying ADT exposure, comparing ADT users with untreated patients, after adjusting for potential confounders, including prior cardiovascular disease.Results:The cohort contained 20,216 prostate cancer patients, followed for 73,570 person-years, during which there were 3,853 cardiovascular events. ADT was associated with a 30% increase in cardiovascular events (adjusted HR = 1.3; 95% CI = 1.2, 1.4). This reflected increases in cardiovascular events associated with GnRH agonists (adjusted HR = 1.3; 95% CI = 1.2, 1.4), degarelix (adjusted HR = 1.5; 95% CI = 1.2, 1.9), but not bicalutamide monotherapy (adjusted HR = 1.0; 95% CI = 0.82, 1.3).Conclusions:There were increased risks of cardiovascular disease with the use of GnRH agonists and degarelix, but not with bicalutamide monotherapy. This is the first study to observe increased cardiovascular risks with degarelix, but the cause of this association is unclear and merits further investigation.