Gupta Dipti, Salmane Chadi, Slovin Susan, Steingart Richard M
Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY, 10065, USA.
Weill Cornell Medical College, New York, NY, USA.
Curr Treat Options Cardiovasc Med. 2017 Aug;19(8):61. doi: 10.1007/s11936-017-0563-1.
Prostate cancer is a common hormone-sensitive malignancy, and androgen deprivation therapy (ADT) is a cornerstone of therapy in advanced disease. The most important and controversial of ADT side effects is cardiovascular (CV) toxicity. Prospective trials have demonstrated that ADT increases CV risk by lowering insulin sensitivity, causing dyslipidemia, and causing weight gain thus mimicking metabolic syndrome. Retrospective data suggests that ADT increases CV risk; however, data on cardiovascular mortality is equivocal. This discrepancy can be explained by study design limitations and selection bias inherent to post hoc analysis of trials not designed to study CV outcomes. Despite the adverse CV and metabolic sequelae of ADT, little data is available for optimal cardiac screening or management in these patients. The short-term CV risk is higher in patients who have had CV events in the year prior to starting ADT. A careful discussion of risk and benefit of ADT must take place with patients with pre-existing CV disease prior to initiating hormonal therapy. The duration of ADT must be considered. We recommend diligent pretherapy screening and optimization of cardiac risk factors and close surveillance especially within the first year of ADT.
前列腺癌是一种常见的激素敏感性恶性肿瘤，雄激素剥夺疗法（ADT）是晚期疾病治疗的基石。ADT最重要且最具争议的副作用是心血管（CV）毒性。前瞻性试验表明，ADT通过降低胰岛素敏感性、导致血脂异常和体重增加，从而模拟代谢综合征，增加了心血管风险。回顾性数据表明，ADT会增加心血管风险；然而，关于心血管死亡率的数据并不明确。这种差异可以通过研究设计的局限性以及对并非为研究心血管结局而设计的试验进行事后分析时固有的选择偏倚来解释。尽管ADT存在不良的心血管和代谢后遗症，但针对这些患者的最佳心脏筛查或管理的可用数据很少。在开始ADT前一年发生过心血管事件的患者，其短期心血管风险更高。在启动激素治疗前，必须与患有心血管疾病的患者仔细讨论ADT的风险和益处。必须考虑ADT的持续时间。我们建议进行勤勉的治疗前筛查，优化心脏危险因素，并进行密切监测，尤其是在ADT的第一年。
