促性腺激素释放激素激动剂使用时间与心血管风险的关系：基于人群的竞争风险分析。
Association between duration of gonadotrophin-releasing hormone agonist use and cardiovascular risks: A population-based competing-risk analysis.
机构信息
Cardio-Oncology Research Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration, Hong Kong, China.
Division of Urology, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
出版信息
Prostate. 2022 Nov;82(15):1477-1480. doi: 10.1002/pros.24423. Epub 2022 Aug 1.
BACKGROUND
Although androgen deprivation therapy has known cardiovascular risks, it is unclear if its duration is related to cardiovascular risks. This study thus aimed to investigate the associations between gonadotrophin-releasing hormone (GnRH) agonist use duration and cardiovascular risks.
METHODS
This retrospective cohort study included adult patients with prostate cancer receiving GnRH agonists in Hong Kong during 1999-2021. Patients who switched to GnRH antagonists, underwent bilateral orchidectomy, had <6 months of GnRH agonist, prior myocardial infarction (MI), or prior stroke was excluded. All patients were followed up until September 2021 for a composite endpoint of MI and stroke. Multivariable competing-risk regression using the Fine-Gray subdistribution model was used, with mortality from any cause as the competing event.
RESULTS
In total, 4038 patients were analyzed (median age 74.9 years old, interquartile range (IQR) 68.7-80.8 years old). Over a median follow-up of 4.1 years (IQR 2.1-7.5 years), longer GnRH agonists use was associated with higher risk of the endpoint (sub-hazard ratio per year 1.04 [1.01-1.06], p = 0.001), with those using GnRH agonists for ≥2 years having an estimated 23% increase in the sub-hazard of the endpoint (sub-hazard ratio 1.23 [1.04-1.46], p = 0.017).
CONCLUSION
Longer GnRH agonist use may be associated with greater cardiovascular risks.
背景
尽管雄激素剥夺疗法已知存在心血管风险，但目前尚不清楚其持续时间是否与心血管风险相关。因此，本研究旨在探讨促性腺激素释放激素（GnRH）激动剂使用时间与心血管风险之间的关系。
方法
本回顾性队列研究纳入了 1999 年至 2021 年期间在香港接受 GnRH 激动剂治疗的前列腺癌成年患者。排除了转用 GnRH 拮抗剂、接受双侧睾丸切除术、使用 GnRH 激动剂<6 个月、既往心肌梗死（MI）或既往中风的患者。所有患者均随访至 2021 年 9 月，以 MI 和中风的复合终点为研究终点。使用 Fine-Gray 亚分布风险模型的多变量竞争风险回归分析，以任何原因导致的死亡为竞争事件。
结果
共分析了 4038 例患者（中位年龄 74.9 岁，四分位距 [IQR] 68.7-80.8 岁）。中位随访时间为 4.1 年（IQR 2.1-7.5 年），GnRH 激动剂使用时间越长，终点风险越高（每年的亚风险比为 1.04 [1.01-1.06]，p=0.001），使用 GnRH 激动剂≥2 年的患者终点亚风险估计增加 23%（亚风险比 1.23 [1.04-1.46]，p=0.017）。
结论
较长时间的 GnRH 激动剂使用可能与更大的心血管风险相关。
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