Cardiology, UCLA Health Ventura, 6633 Telephone Rd. Suite 120, Ventura, CA, 93003, USA.
Cardiology, UCLA Health Simi Valley, 2655 First Street Suite 360, Simi Valley, CA, 93065, USA.
Curr Oncol Rep. 2019 Aug 24;21(10):91. doi: 10.1007/s11912-019-0841-z.
This review paper is a comprehensive look at the cardiovascular disease (CVD) risk that is associated with the use of androgen deprivation therapy in prostate cancer. It summarizes when certain cancer therapies are indicated and should guide physicians in identifying patients at increased risk for CVD during prostate cancer therapy.
GnRH agonist use and maximal androgen blockade (MAB) are associated with increased CVD. This association is not observed in patients on GnRH antagonists. One example is the novel agent abiraterone, which is associated with hypertension whose mechanisms are likely driven by mineralocorticoid excess. Incidence of cardiovascular disease events is greatest when using MAB, especially in patients with pre-existing CVD. There is significant confounding that exists given patients with more aggressive cancers tend to be older and have more co-existing CVD. Given the lower CVD event rates with GnRH antagonists, future studies and strategies should focus on high-risk cancer patients with co-existing CVD receiving antagonists over agonists.
本综述文章全面探讨了前列腺癌患者接受雄激素剥夺疗法（androgen deprivation therapy）与心血管疾病（cardiovascular disease，CVD）风险之间的关联。它总结了何时需要使用特定的癌症疗法，并应指导医生在前列腺癌治疗期间识别 CVD 风险增加的患者。
促性腺激素释放激素激动剂（gonadotropin-releasing hormone agonist，GnRH agonist）的使用和最大雄激素阻断（maximal androgen blockade，MAB）与 CVD 风险增加相关。但这种关联在使用 GnRH 拮抗剂的患者中并不明显。一个例子是新型药物阿比特龙（abiraterone），它与高血压相关，其机制可能是由盐皮质激素过多驱动的。在使用 MAB 时，心血管疾病事件的发生率最高，尤其是在患有预先存在的 CVD 的患者中。由于具有侵袭性更强的癌症的患者往往年龄更大且合并 CVD 的情况更多，因此存在显著的混杂因素。鉴于 GnRH 拮抗剂的 CVD 事件发生率较低，未来的研究和策略应关注合并 CVD 的高危癌症患者，他们应接受拮抗剂而非激动剂治疗。
