他汀类药物和睾酮替代疗法与老年前列腺癌男性心血管疾病的联合关联：SEER-Medicare 2007-2015。
Joint association of statins and testosterone replacement therapy with cardiovascular disease among older men with prostate cancer: SEER-Medicare 2007-2015.
机构信息
Deparment of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA.
Deparment of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA.
出版信息
Cancer Epidemiol. 2022 Aug;79:102172. doi: 10.1016/j.canep.2022.102172. Epub 2022 May 4.
BACKGROUND
Use of statins and testosterone replacement therapy (TTh) have been independently linked with prostate cancer (PCa) and cardiovascular diseases (CVD). However, there is a research gap about the joint association of statins and TTh with CVD among PCa survivors and a matched cancer-free cohort.
METHODS
In SEER-Medicare 2007-2015 (N = 35,990 men), we identified 17,995 PCa survivors, and 17,995 age- and index-matched cancer-free men. Pre-diagnostic prescription of statins and TTh was ascertained for this analysis and examined in two matched cohorts. Weighted multivariable-adjusted conditional logistic regression models were used to evaluate the independent and joint associations of statins and TTh with CVD.
RESULTS
We found that independently statins (OR = 0.48, 95% CI: 0.44-0.53) and TTh (OR = 0.74, 95% CI: 0.0.61-0.90) were each inversely associated with CVD in the overall sample. TTh plus statins was inversely associated with CVD (OR = 0.50, 95% CI: 0.36-0.70, P = 0.03). Similar associations were observed among the matched cancer-free cohort. Among PCa survivors, only statins (OR = 0.62, 95% CI: 0.56-0.68) and combination of TTh plus statins (OR = 0.63, 95% CI: 0.44-0.90) were inversely associated with CVD, but not the independent use of TTh.
CONCLUSION
Pre-diagnostic use of statins and TTh, independent or in combination, were inversely associated with CVD in the overall and cancer-free populations, but among PCa survivors it was mainly use of statins, not TTh. Greater reduced effects on CVD were observed with statins or in combination with statins, but not with TTh. Future studies need to confirm these associations among older men with aggressive PCa.
背景
他汀类药物和睾丸激素替代疗法（TTh）的使用已被独立地与前列腺癌（PCa）和心血管疾病（CVD）相关联。然而，在 PCa 幸存者和匹配的无癌症队列中，关于他汀类药物和 TTh 联合与 CVD 的关联的研究存在空白。
方法
在 SEER-Medicare 2007-2015 年（N=35990 名男性）中，我们确定了 17995 名 PCa 幸存者和 17995 名年龄和指数匹配的无癌症男性。在此分析中确定了他汀类药物和 TTh 的预先诊断处方，并在两个匹配的队列中进行了检查。使用加权多变量调整条件逻辑回归模型来评估他汀类药物和 TTh 与 CVD 的独立和联合关联。
结果
我们发现，他汀类药物（OR=0.48，95%CI：0.44-0.53）和 TTh（OR=0.74，95%CI：0.61-0.90）在总体样本中均与 CVD 呈负相关。TTh 加他汀类药物与 CVD 呈负相关（OR=0.50，95%CI：0.36-0.70，P=0.03）。在匹配的无癌症队列中也观察到了类似的关联。在 PCa 幸存者中，只有他汀类药物（OR=0.62，95%CI：0.56-0.68）和 TTh 加他汀类药物的联合使用（OR=0.63，95%CI：0.44-0.90）与 CVD 呈负相关，而独立使用 TTh 则没有。
结论
预先诊断使用他汀类药物和 TTh，独立或联合使用，与总体和无癌症人群中的 CVD 呈负相关，但在 PCa 幸存者中，主要是使用他汀类药物，而不是 TTh。与 TTh 相比，使用他汀类药物或与他汀类药物联合使用时，对 CVD 的降低效果更大。需要进一步的研究来确认这些关联在患有侵袭性 PCa 的老年男性中的存在。
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