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Published on: March 6, 2018
The Risk of Cardiovascular Disease in Prostate Cancer Patients Receiving Androgen Deprivation Therapies
Chris R Cardwell1, Joe M O'Sullivan2,3, Suneil Jain2,3
1From the Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom.
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.
Insights
Androgen deprivation therapy (ADT) increases cardiovascular risks, especially with GnRH agonists and degarelix. Bicalutamide monotherapy did not show this increased risk in prostate cancer patients.
Area of Science:
- Oncology
- Cardiology
- Pharmacology
Background:
- Androgen deprivation therapy (ADT) is crucial for prostate cancer management.
- ADT use is linked to increased cardiovascular disease (CVD) risk.
- Specific ADT types, including newer agents like degarelix, require further CVD risk investigation.
Purpose of the Study:
- To investigate the association between different types of ADT and cardiovascular disease risk.
- To compare CVD risk across gonadotropin-releasing hormone (GnRH) agonists, degarelix, and bicalutamide monotherapy in prostate cancer patients.
Main Methods:
- Retrospective cohort study using Scottish Cancer Registry and Prescribing Information System data (2009-2015).
- Identified 20,216 prostate cancer patients with 73,570 person-years of follow-up.
- Used Cox regression to analyze time-varying ADT exposure and cardiovascular events (hospitalization or death), adjusting for confounders.
Main Results:
- Overall ADT use was associated with a 30% increase in cardiovascular events (aHR=1.3; 95% CI=1.2-1.4).
- GnRH agonists showed a 30% increase (aHR=1.3; 95% CI=1.2-1.4).
- Degarelix was associated with a 50% increase (aHR=1.5; 95% CI=1.2-1.9), while bicalutamide monotherapy showed no significant increase (aHR=1.0; 95% CI=0.82-1.3).
Conclusions:
- GnRH agonists and degarelix are associated with increased cardiovascular disease risk.
- This study is the first to report an increased cardiovascular risk with degarelix.
- The underlying mechanisms for degarelix-associated cardiovascular risk require further research.
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