Absolute and Relative Risk of Cardiovascular Disease in Men With Prostate Cancer: Results From the Population-Based PCBaSe Sweden

Hemelrijck, Mieke Van; Garmo, Hans; Holmberg, Lars; Ingelsson, Erik; Bratt, Ola; Bill‐Axelson, Anna; Lambe, Mats; Stattin, Pär; Adolfsson, Jan

doi:10.1200/jco.2010.29.1567

Cited by 183 publications

(191 citation statements)

References 28 publications

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“…In a population-based observational study comprising over 37,000 men from the Veterans Administration patient database, Keating et al found that ADT use was associated with an increased the risk of MI and stroke. 6 Additional analyses using the SEER database, 19 Danish Cancer Registry, 20 and Swedish PcBaSE 21 have corroborated this data, yet others have found no clear association between use of gonadotropin-releasing hormone agonists and CE risk. 22 Meta-analyses have been conducted to reconcile this data, 23,24 but fundamental weaknesses of observational studies limit interpretation.…”

Section: Discussionmentioning

confidence: 52%

Long-term Impact of Androgen Deprivation Therapy on Cardiovascular Morbidity after Radiotherapy for Clinically Localized Prostate Cancer

Steinberger

Pei

Zhang

et al. 2014

International Journal of Radiation Oncology*Biology*Physics

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OBJECTIVE-To characterize the impact of androgen-deprivation therapy (ADT) on the incidence of cardiovascular events (CE) in prostate cancer patients treated with radiotherapy (RT).METHODS-2211 patients with localized prostate cancer were treated with RT from 1988-2008 at our institution. 991 patients (44.8%) received ADT at the time of RT for a median of 6.1 months. Salvage ADT was initiated prior to CE in 365 men (16.5%) at a median of 5.5 years (range, 0.6 to 18.4 years) after RT and continued for a median of 4.3 years. A nomogram was constructed to predict the 10-year risk of CE post-RT.RESULTS-Patients receiving ADT at the time of RT exhibited significantly higher 10-year incidence of CE (19.6%, 95% CI 17.0-22.6%) than those not receiving ADT (14.3%, 95% CI 12.2%-16.7%, P = .005). On multivariate analysis, both ADT at the time of RT (P= .007) and the time of salvage (P = .0004) were associated with increased CE risk, as were advanced age (P = . 02), smoking (P = .0007), history of diabetes (P = .0007), and history of CE before RT (P < . 0001). A nomogram using patient age, smoking status, history of pre-RT CE, history of diabetes, and ADT use at the time of RT predicted the rate of 10-year CE with a C-index of 0.81 (95% CI, 0.72-0.88).CONCLUSION-While ADT is often an essential part of prostate-cancer treatment, patients should be counseled regarding increased risks of CE and prophylactic efforts should be considered to mitigate that risk.

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Section: Discussionmentioning

confidence: 52%

Long-term Impact of Androgen Deprivation Therapy on Cardiovascular Morbidity after Radiotherapy for Clinically Localized Prostate Cancer

Steinberger

Pei

Zhang

et al. 2014

International Journal of Radiation Oncology*Biology*Physics

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“…However, androgen deprivation may cause atherosclerotic plaque progression and instability, 15 and its use has been associated with an increased risk of coronary heart disease. [16][17][18][19][20] Consistent with evidence that aging 21 and cancer 22 are associated with an increased risk of venous thromboembolism (i.e., pulmonary embolism and deep venous thrombosis), a population-based study of the Swedish National Prostate Cancer Register demonstrated that prostate cancer was associated with an increased risk of venous thromboembolism, and men with prostate cancer treated with androgen deprivation therapy were at greatest risk for venous thrmoboembolism. 23 We sought to corroborate the association of androgen deprivation therapy with venous thromboembolism among older Americans with prostate cancer.…”

Section: Introductionmentioning

confidence: 65%

170 Androgen Deprivation Therapy for Non-Metastatic Prostate Cancer Is Associated With an Increased Risk of Peripheral Arterial Disease and Venous Thromboembolism

Williams¹,

O’Malley

Smith

et al. 2012

Journal of Urology

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Background-Previous studies demonstrate that androgen deprivation therapy with gonodotropin-releasing hormone (GnRH) agonists and orchiectomy for prostate cancer is associated with cardiovascular disease. However, few studies have examined its effect on the peripheral vascular system.Objective-To study the risk of peripheral arterial disease and venous thromboembolism associated with androgen deprivation therapy for prostate cancer.Design, Settings and Participants-Population-based observational study of 182,757 U.S. men aged 66 years and older who were diagnosed with loco-regional prostate cancer from 1992 to 2007, of whom 47.8% received GnRH agonists and 2.2% orchiectomy.Measurements-We used Cox proportional hazards models with time-varying treatment variables to assess whether treatment with GnRH agonists or orchiectomy was associated with peripheral arterial disease and/or venous thromboembolism.Results and limitations-Overall, 47.8% of men received a GnRH agonist during follow-up and 2.2% underwent orchiectomy. GnRH agonist use was associated with an increased risk of incident peripheral arterial disease (adjusted hazard ratio [HR], 1.15, 95% confidence interval [CI] 1.11-1.19) and incident venous thromboembolism (adjusted HR, 1.1, 95% CI 1.04-1.16). In addition, orchiectomy was associated with an increased risk of peripheral arterial disease (adjusted HR, 1.14, 95% CI 1.03-1.27) and venous thromboembolism (adjusted HR, 1.22, 95% CI 1.07-1.40). Limitations include the observational study design, inability to assess the use of oral antiandrogens as monotherapy or combined androgen deprivation.Conclusions-Androgen deprivation therapy for loco-regional prostate cancer is associated with an increased risk of peripheral artery disease and venous thromboembolism. Additional research is needed to better understand the potential risks and benefits, so that these treatments can be targeted to patients where the benefits are most clear.

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“…Antiandrogen monotherapy was associated with decreased mortality from congestive heart failure in comparison with the GnRH agonist monotherapy and the combination of GnRH agonist and antinadrogen (41). The therapy combination including GnRH agonist and antiandrogen has been associated with increased prevalence of heart failure (OR 3.19, 95% CI 1.10, 9.27) and hospitalization for heart failure (OR 3:39; 95% CI 1.7, 10.70) compared to patients without this combined treatment (34).…”

Section: Clinical Studiesmentioning

confidence: 99%

Androgen deprivation therapy and cardiovascular complications

Poljak¹,

Hulín²,

Maruscakova³

et al. 2017

BLL

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Cardiovascular complications associated with the use of antiandrogens have already been known for some time. Based on the results of the latest meta-analyses and clinical studies published in the last few years, the attention of the scientifi c community is focused on the deleterious cardiovascular effects of gonadotropine-releasing hormon agonists in context of the androgen deprivating therapy. The cardiac toxicity is a problem especially in patients with preexisting cardiovascular comorbidities. Increased arterial wall thickening along with endothelial dysfunction has been observed in patients with descreased androgens levels in the peripheral blood. The treatment with gonadotropine-releasing hormon agonists may disrupt the intracellular concentration of calcium ions and the contractile process and potentially result in pathological remodelling of heart. Here, we give several possible mechanisms of action of gonadotropine-releasing hormon agonists on the cardiovascular system that may be a potential explanation of the clinical observations (Ref. 44). Text in PDF www.elis.sk.

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Absolute and Relative Risk of Cardiovascular Disease in Men With Prostate Cancer: Results From the Population-Based PCBaSe Sweden

Cited by 183 publications

References 28 publications

Long-term Impact of Androgen Deprivation Therapy on Cardiovascular Morbidity after Radiotherapy for Clinically Localized Prostate Cancer

Long-term Impact of Androgen Deprivation Therapy on Cardiovascular Morbidity after Radiotherapy for Clinically Localized Prostate Cancer

170 Androgen Deprivation Therapy for Non-Metastatic Prostate Cancer Is Associated With an Increased Risk of Peripheral Arterial Disease and Venous Thromboembolism

Androgen deprivation therapy and cardiovascular complications

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