King's College London, Division of Cancer Studies, Cancer Epidemiology Group, London, UK.
Ferring Pharmaceuticals, Clinical R&D, Copenhagen, Denmark.
Eur Urol. 2015 Sep;68(3):386-96. doi: 10.1016/j.eururo.2014.11.039. Epub 2014 Dec 5.
Whether androgen deprivation therapy (ADT) for men with prostate cancer (PCa) increases the risk of cardiovascular disease (CVD) remains controversial. Pooled analyses using data from randomised controlled trials suggest no increased risk of fatal CVD following ADT, but no pooled analyses exist for observational studies.
To perform a meta-analysis using observational data on ADT and risk of CVD events in men with PCa.
PubMed and Embase were searched using predefined inclusion criteria to perform meta-analyses on associations between types of ADT and nonfatal and fatal CVD outcomes using information from observational studies. Random effects meta-analyses were conducted to estimate relative risks (RRs) and 95% confidence intervals (CIs).
A total of eight observational studies were identified studying at least one type of ADT and a nonfatal or fatal CVD outcome. The RR for risk of any type of nonfatal CVD was 1.38 (95% CI, 1.29-1.48) for men with PCa on gonadotropin-releasing hormone (GnRH) agonists, compared with men not treated with ADT. When analysing nonfatal ischemic heart disease only, the RR was 1.39 (95% CI, 1.26-1.54). The associations between GnRH agonists and nonfatal or fatal myocardial infarction or stroke were even stronger: RR: 1.57 (95% CI, 1.26-1.94) and RR: 1.51 (95% CI, 1.24-1.84), respectively. The results for other types of ADT in relation to the risk of any nonfatal CVD were RR: 1.44 (95% CI, 1.28-1.62) for orchiectomy and RR: 1.21 (95% CI, 1.07-1.367) for antiandrogens.
Observational data show a consistent positive association between ADT and the risk of CVD. This finding supports the need for future randomised trials of PCa patients that include older patients and men with multiple comorbidities to better reflect the general population.
We investigated all the available data from observational studies on hormonal treatment for prostate cancer and its possible cardiovascular adverse effects. We found consistent evidence that this treatment may increase the risk of cardiovascular disease.
雄激素剥夺疗法（ADT）是否会增加前列腺癌（PCa）患者的心血管疾病（CVD）风险仍存在争议。使用随机对照试验数据进行的汇总分析表明，ADT 后致命 CVD 风险没有增加，但没有针对观察性研究的汇总分析。
使用观察性数据对接受 ADT 的 PCa 男性的 CVD 事件风险进行荟萃分析。
使用预定义的纳入标准在 PubMed 和 Embase 上进行搜索，对使用观察性研究中的信息的 ADT 类型与非致命性和致命性 CVD 结局之间的关联进行荟萃分析。采用随机效应荟萃分析来估计相对风险（RR）和 95%置信区间（CI）。
共确定了八项观察性研究，研究了至少一种 ADT 类型和非致命性或致命性 CVD 结局。与未接受 ADT 的男性相比，接受促性腺激素释放激素（GnRH）激动剂治疗的 PCa 男性发生任何类型非致命性 CVD 的风险 RR 为 1.38（95%CI，1.29-1.48）。仅分析非致命性缺血性心脏病时，RR 为 1.39（95%CI，1.26-1.54）。GnRH 激动剂与非致命性或致命性心肌梗死或卒中之间的关联更强：RR：1.57（95%CI，1.26-1.94）和 RR：1.51（95%CI，1.24-1.84）。与任何非致命性 CVD 风险相关的其他类型 ADT 的结果为 RR：1.44（95%CI，1.28-1.62）行睾丸切除术和 RR：1.21（95%CI，1.07-1.367）用于抗雄激素治疗。
观察性数据显示 ADT 与 CVD 风险之间存在一致的正相关关系。这一发现支持未来对包括老年患者和患有多种合并症的 PCa 患者进行随机试验的需要，以便更好地反映一般人群。
我们调查了所有关于前列腺癌激素治疗及其可能的心血管不良影响的观察性研究的数据。我们发现一致的证据表明，这种治疗可能会增加患心血管疾病的风险。
