Cardiovascular disease risk and androgen deprivation therapy in patients with localised prostate cancer: a prospective cohort study.
Cardiovascular disease risk and androgen deprivation therapy in patients with localised prostate cancer: a prospective cohort study.
复制标题
DOI：
10.1038/bjc.2017.280
复制
发表时间：
2017-10-10
影响因子：
8.8
通讯作者：
Potosky AL
中科院分区：
文献类型：
--
作者：
Haque R;UlcickasYood M;Xu X;Cassidy-Bushrow AE;Tsai HT;Keating NL;Van Den Eeden SK;Potosky AL
随着雄激素剥夺疗法（ADT）越来越多地用于局限性前列腺癌男性，我们的目标是检查ADT与心血管疾病（CVD）风险之间的关联。我们利用加州一个大型医疗保健系统的记录进行了一项前瞻性队列研究。该研究纳入了新诊断的局限性前列腺癌男性（1998-2008年），他们最初接受了主动监测（N=7637），并随访至2010年。我们检查了10个单独的CVD结果。考克斯比例风险模型纳入了随时间变化的治疗变量，并控制了人种/种族、年龄和肿瘤特征、复发风险、CVD药物使用和CVD风险因素。在7637例受试者中，近30%暴露于ADT。在多变量分析中，ADT与既往无CVD的男性心力衰竭风险增加相关（校正HR=1.81，95% CI 1.40-2.32）。仅在既存CVD患者中观察到心律失常（校正HR=1.44，95% CI 1.02-2.01）和传导障碍（校正HR=3.11，95% CI 1.22，7.91）风险升高。在最初接受积极监测的临床局限性前列腺癌男性中，ADT与无任何既存CVD男性的心力衰竭风险更高相关。我们还发现有心血管疾病的男性发生心律失常和传导障碍的风险增加。这项研究为识别接受ADT治疗的高危男性提供了基础，这些男性可能受益于定期心脏监测和生活方式改变的建议。
As androgen deprivation therapy (ADT) is increasingly being used in men with localised prostate cancer, our goal was to examine the association between ADT and the risk of cardiovascular disease (CVD). We conducted a prospective cohort study using records of a large health-care system in California. The study included men with newly diagnosed localised prostate cancer (1998–2008) who initially underwent active surveillance (N=7637) and were followed through 2010. We examined 10 individual CVD outcomes. Cox proportional hazard models incorporated time-varying treatment variables and controlled for race/ethnicity, age, and tumour characteristics, recurrence risk, CVD medication use, and CVD risk factors. Of the 7637 subjects, nearly 30% were exposed to ADT. In the multivariable analyses, ADT was associated with an increased risk of heart failure (adjusted HR=1.81, 95% CI 1.40–2.32) in men without preexisting CVD. Elevated risks of arrhythmia (adjusted HR=1.44, 95% CI 1.02–2.01), and conduction disorder (adjusted HR=3.11, 95% CI 1.22, 7.91) were only observed among patients with preexisting CVD. In men with clinically localised prostate cancer who were initially under active surveillance, ADT was associated with a greater risk of heart failure in men without any preexisting CVD. We also found an increased risk of arrhythmia and conduction disorder in men with preexisting CVD. This study provides the basis for identifying high-risk men treated with ADT who might benefit from regular cardiac monitoring and lifestyle modification recommendations.
登录
查看更多内容
DOI：
10.1097/00001648-199001000-00010
发表时间：
1990-01-01
期刊：
Epidemiology (Cambridge, Mass.)
影响因子：
--
作者：
Rothman, K J
通讯作者：
Rothman, K J
DOI：
10.1093/jnci/djp404
发表时间：
2010-01-06
期刊：
JOURNAL OF THE NATIONAL CANCER INSTITUTE
影响因子：
--
作者：
Keating, Nancy L.;O'Malley, A. James;Smith, Matthew R.
通讯作者：
Smith, Matthew R.
影响因子：
4.2
作者：
Martin-Merino, Elisa;Johansson, Saga;Garcia Rodriguez, Luis A.
通讯作者：
Garcia Rodriguez, Luis A.
影响因子：
23.4
作者：
Albertsen, Peter C.;Klotz, Laurence;Nilsson, Jan
通讯作者：
Nilsson, Jan
影响因子：
5.8
作者：
Hak, AE;Witteman, JCM;Pols, HAP
通讯作者：
Pols, HAP