Is androgen deprivation therapy for prostate cancer associated with cardiovascular disease? A meta‐analysis and systematic review

Abstract

Background: Androgen deprivation therapy (ADT) is widely being applied in men who suffered from prostate cancer. Whether androgen deprivation therapy (ADT) is associated with an increased risk of developing cardiovascular-related disease is poorly defined. Objectives:The aim of the present meta-analysis is to explore the relationship between ADT and the risk of cardiac events. Materials and methods:For this systematic review and meta-analysis, we searched databases from inception to April 2019 for randomized controlled trials (RCT) or observational studies that reported data on ADT administration and cardiac event incidence. The connection was evaluated through estimating relative risk ratio (RR) and 95% confidence intervals (CIs). Results:A significantly increased acute myocardial infarction (AMI) was detected in the ADT group compared with the control group (RR = 1.19, 95% confidence interval (CI), 1.02-1.39, P < .05). A significant difference between cardiovascular disease (CVD) andADT was also observed, with summary RR = 1.25, 95% CI, 1.11-1.40, P < .05. Furthermore, our study also suggested ADT was not related to increased incidence of sudden cardiac death (SCD) (RR = 1.13, 95% CI, 0.92-1.38, P = .24); AMI and CVD were not connected with the duration of ADT (AMI: RR = 1.31; 95% CI, 0.66-2.63, P = .44, for > 5 year group; CVD: RR = 1.12, 95% CI, 0.97-1.30, P = .12, for > 5 year group). In addition, the RR for risk of CVD was 1.28 (95% CI, 1.01-1.62, P < .05) for men with PCa on new hormonal agents.Discussion: Various ADT modalities have different impact on cardiovascular disease risk in different level. Long-term application of ADT is not associated with increased risk of AMI and CVD. Both abiraterone and enzalutamide could significantly increase the incidence of cardiac events in patients who suffered from prostate cancer. Cautions and periodic cardiovascular elevation are necessary for patients before the ADT starting. Conclusions:Androgen deprivation therapy is associated with increased risk of AMI, CHD, in contrast, this association is not detected in SCD. K E Y W O R D Sandrogen deprivation therapy, cardiovascular disease, prostate cancer

Cardiovascular Complications of Prostate Cancer Treatment

“…In addition, the duration of ADT was not relevant in terms of acute MI and CVD (RR 1.31, 95% CI: 0.66-2.63, p 0.44; RR 1.12, 95% CI: 0.97-1.30, p 0.12, resp.) (Liang et al, 2020).…”

Androgen Deprivation Therapy, Hypogonadism and Cardiovascular Toxicity in Men with Advanced Prostate Cancer

“…Liang et al [ 61 ] published a meta-analysis regarding ADT and the risk of cardiovascular disease and found an association between ADT and the occurrence of myocardial infarction but not of sudden cardiac death. The risk is increased in patients receiving abiraterone and enzalutamide.…”

Cardiovascular Risks of Androgen Deprivation Therapy for Prostate Cancer

“…Up to now, seven systematic meta-analyses have investigated the relationship between ADT and CV mortality and morbidity ( Table 2 ) [ 41 42 43 44 45 46 47 ]. The number of the studies included ranges from four to 13, with the patients under ADT considered from 2,000 to 189,202 ( Table 2 ).…”

“…The impact of ADT duration and the role of the new AA on CV risk were investigated only in one study [ 47 ]. Interestingly, the negative effects of ADT were more evident in those studies lasting less than five years, although the differences were not statistically significant ( Supplement Fig.…”

“…However, concerns related to CV toxicity for both drugs have been raised [ 2 ]. By performing a specific sub-analysis comparing the effects of traditional AA to abiterone and enzalutamide, Liang et al [ 47 ] showed that the latter were associated with an increased CV risk, although not statistically different when compared to traditional AA ( Supplement Fig. C ).…”