Influence of age on incident diabetes and cardiovascular disease in prostate cancer survivors receiving androgen deprivation therapy.
Influence of age on incident diabetes and cardiovascular disease in prostate cancer survivors receiving androgen deprivation therapy.
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DOI：
10.1016/j.juro.2014.11.006
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发表时间：
2015-04
期刊：
影响因子：
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通讯作者：
Penson DF
中科院分区：
文献类型：
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作者：
Morgans AK;Fan KH;Koyama T;Albertsen PC;Goodman M;Hamilton AS;Hoffman RM;Stanford JL;Stroup AM;Resnick MJ;Barocas DA;Penson DF
观察数据表明雄激素剥夺疗法会增加患糖尿病和心血管疾病的风险。利用基于 PCOS 人群的数据，我们评估了诊断时的年龄和合并症是否影响雄激素剥夺治疗与糖尿病和心血管疾病的关联。我们确定了 1994 年至 1995 年诊断出的非转移性前列腺癌男性，并在 2009 年至 2010 年进行了随访。我们使用多变量逻辑回归模型来评估雄激素剥夺治疗暴露（2 年或更少、超过 2 年或无）与糖尿病和心血管疾病发生率的关系，并调整诊断时的年龄、种族、分期和合并症。在 3,526 名符合资格的研究参与者中，有 2,985 名没有糖尿病和 3,112 名没有心血管疾病的参与者构成了高危人群。对于 70 岁之前被诊断患有前列腺癌的男性来说，雄激素剥夺疗法与糖尿病或心血管疾病风险增加无关。老年男性长期雄激素剥夺治疗和诊断年龄增加与糖尿病（76 岁时 OR 2.1，95% CI 1.0–4.4）和心血管疾病（74 岁时 OR 1.9，95% CI 1.0–3.5）风险增加相关。与没有合并症的男性相比，有合并症的男性患糖尿病（OR 4.3，95% CI 2.3–7.9）和心血管疾病（OR 8.1，95% CI 4.3–15.5）的风险更大。对于年龄超过 75 岁的前列腺癌男性，尤其是患有其他合并症的男性，长期接受雄激素剥夺治疗会增加心血管疾病和糖尿病的风险。接受长期雄激素剥夺治疗的老年男性应密切监测糖尿病和心血管疾病。
Observational data suggest that androgen deprivation therapy increases the risk of diabetes and cardiovascular disease. Using data from the population based PCOS we evaluated whether age at diagnosis and comorbidity impact the association of androgen deprivation therapy with incident diabetes and cardiovascular disease. We identified men with nonmetastatic prostate cancer diagnosed from 1994 to 1995 who were followed through 2009 to 2010. We used multivariable logistic regression models to assess the relationship of androgen deprivation therapy exposure (2 or fewer years, greater than 2 years or none) with incident diabetes and cardiovascular disease, adjusting for age at diagnosis, race, stage and comorbidity. Of 3,526 eligible study participants 2,985 without diabetes and 3,112 without cardiovascular disease comprised the cohorts at risk. Androgen deprivation therapy was not associated with an increased risk of diabetes or cardiovascular disease in men diagnosed with prostate cancer before age 70 years. Prolonged androgen deprivation therapy and increasing age at diagnosis in older men was associated with an increased risk of diabetes (at age 76 years OR 2.1, 95% CI 1.0–4.4) and cardiovascular disease (at age 74 years OR 1.9, 95% CI 1.0–3.5). Men with comorbidities were at greater risk for diabetes (OR 4.3, 95% CI 2.3–7.9) and cardiovascular disease (OR 8.1, 95% CI 4.3–15.5) than men without comorbidities. Prolonged androgen deprivation therapy exposure increases the risk of cardiovascular disease and diabetes in men diagnosed with prostate cancer who are older than approximately 75 years, especially those with other comorbidities. Older men who receive prolonged androgen deprivation therapy should be closely monitored for diabetes and cardiovascular disease.