Androgen Deprivation Therapy and the Risk of Coronary Heart Disease and Heart Failure in Patients with Prostate Cancer A Nested Case-Control Study in UK Primary Care
Androgen Deprivation Therapy and the Risk of Coronary Heart Disease and Heart Failure in Patients with Prostate Cancer A Nested Case-Control Study in UK Primary Care
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DOI：
10.2165/11594540-000000000-00000
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发表时间：
2011-01-01
期刊：
影响因子：
4.2
通讯作者：
Garcia Rodriguez, Luis A.
中科院分区：
文献类型：
--
作者：
Martin-Merino, Elisa;Johansson, Saga;Garcia Rodriguez, Luis A.
背景：雄激素剥夺疗法（ADT）用于延缓前列腺癌患者的肿瘤发展和提高生存率。然而，一些随机对照试验和观察性研究表明，ADT可能会增加心血管事件的风险。目的：本研究的目的是评估在英国初级保健中接受ADT的前列腺癌患者发生冠心病（CHD）和心力衰竭（HF）的风险，并评估与单独ADT和联合ADT相关的风险。方法：英国全科医学研究数据库被用于确定1999-2005年期间首次诊断为前列腺癌的患者队列。随访这些患者以评估急性心肌梗死（AM！）的发生率，CHD死亡、HF事件和住院治疗死于急性失代偿性HF。进行巢式病例对照分析，以评估这些结果与抗雄激素治疗，以及不同类型的ADT和组合的ADT.Results的风险：目前抗雄激素的使用是一个显着增加的住院风险，由于HF（比值比[OR] 2.15; 95%CI 1.08，4.29），但不是事件HF，CHD或AMI。当单独评估时，比卡鲁胺或环丙孕酮的使用与AM的风险无显著相关性！或CHD。目前使用比卡鲁胺50 mg/天与HF风险显著增加相关（OR 3.28; 95% CI 1.31，8.18）;然而，仅在接受比卡鲁胺50 mg/天联合促黄体生成素释放激素（LHRH）受体激动剂的患者中发现HF风险增加。在接受比卡鲁胺50 mg/天单药治疗的患者中，无住院HF病例，目前使用比卡鲁胺150 mg/天与住院HF风险之间无显著相关性。LHRH激动剂和抗雄激素联合治疗与CHD风险显著增加相关（OR 4.35; 95% CI 1.94，9.75），AMI（OR 3.57; 95% CI 1.44，8.86），发生HF（OR 3.19; 95% CI 1.10，9.27）和住院HF（OR 3.39; 95% CI 1.07，10.70）。结论：在前列腺癌患者中，LHRH激动剂和抗雄激素的联合治疗与CHD、AMI、发生HF和住院HF。个体治疗似乎不会增加这些结局的风险。
Background: Androgen deprivation therapy (ADT) is used to delay tumour development and improve survival in patients with prostate cancer. However, several randomized controlled trials and observational studies have suggested that ADT may increase the risk of cardiovascular events.Objective: The aim of the study was to evaluate the risk of coronary heart disease (CHD) and heart failure (HF) in patients with prostate cancer receiving ADT in UK primary care, and to evaluate the risks associated with individual ADT and combination ADT.Methods: The UK General Practice Research Database was used to identify a cohort of patients with a first prostate cancer diagnosis during 1999-2005. These patients were followed up to assess the occurrence of acute myocardial infarction (AM!), death from CHD, incident HF and hospitalization die to acute decompensated HF. Nested case-control analyses were performed to assess the risk of these outcomes associated with anti-androgen therapy, as well as different types of ADT and combinations of ADT.Results: Current anti-androgen use was associated with a significant increase in the risk of hospitalization due to HF (odds ratio [OR] 2.15; 95% CI 1.08, 4.29), but not of incident HF, CHD or AMI. When assessed individually, there was no significant association of bicalutamide or cyproterone use with the risk of AM! or CHD. Current use of bicalutamide 50 mg/day was Associated with a significant increase in the risk of HF (OR 3.28; 95% CI 1.31, 8.18); however, this increased risk of HF was only found in patients taking bicalutamide 50 mg/day in combination with luteinizing hormone-releasing hormone (LHRH) receptor agonists. There were no cases of hospitalized HF in patients taking bicalutamide 50 mg/day as monotherapy and there was no significant association between current use of bicalutamide 150 mg/day and the risk of hospitalized HF. Combination therapy with LHRH agonists and anti-androgens was associated with a significant increase in the risk of CHD (OR 4.35; 95% CI 1.94, 9.75), AMI (OR 3.57; 95% CI 1.44, 8.86), incident HF (OR 3.19; 95% CI 1.10, 9.27) and hospitalized HF (OR 3.39; 95% CI 1.07, 10.70) compared with non-use of these drugs.Conclusions: In men with prostate cancer, combination therapy with LHRH agonists and anti-androgens is associated with significant increases in the risk of CHD, AMI, incident HF and hospitalized HF. Individual therapies do not appear to increase the risk of these outcomes.