Chan Jeffrey Shi Kai, Lee Yan Hiu Athena, Liu Kang, Hui Jeremy Man Ho, Dee Edward Christopher, Ng Kenrick, Satti Danish Iltaf, Liu Tong, Tse Gary, Ng Chi Fai
Cardio-Oncology Research Unit, Cardiovascular Analytics Group, Hong Kong, China.
Division of Urology, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
Eur Urol Open Sci. 2022 Dec 15;47:3-11. doi: 10.1016/j.euros.2022.11.002. eCollection 2023 Jan.
Androgen deprivation therapy (ADT) worsens glycaemic control and cardiovascular outcomes. The prognostic value of visit-to-visit HbA1c variability (VVHV) has been unexplored in prostate cancer (PCa) patients receiving ADT.
To explore the effect of ADT on VVHV and the cardiovascular prognostic value of VVHV.
PCa patients receiving ADT in Hong Kong between January 1, 1993 and March 31, 2021 were included in this retrospective cohort study. Those with fewer than three HbA1c results available within 3 yr after ADT initiation, <6 mo of ADT, missing baseline HbA1c, prior diagnosis of any component of major adverse cardiovascular events (MACEs), and MACEs occurring within 3 yr were excluded. Patients were followed up until September 31, 2021.
The outcome was MACEs (composite of heart failure, myocardial infarction, stroke, and cardiovascular mortality). VVHV was calculated from HbA1c levels within 3 yr after and, separately where available, before ADT initiation using coefficient of variation (CV; standard deviation [SD] divided by mean) and average real variability (ARV; average difference between consecutive measurements).
Altogether, 1065 patients were analysed (median age 74.4 yr old [interquartile range 68.3-79.5 yr]). In 709 patients with VVHV available before and after ADT initiation, VVHV increased after ADT initiation ( < 0.001), with 473 (66.2%) and 474 (66.9%) having increased CV and ARV, respectively. Over a median follow-up of 4.3 yr (2.8-6.7 yr), higher VVHV was associated with a higher risk of MACEs (adjusted hazard ratio [per SD] for CV 1.21 [95% confidence interval: 1.02, 1.43], = 0.029; ARV 1.25 [1.06, 1.48], = 0.008). Limitations included residual confounding and selection bias.
In PCa patients receiving ADT, VVHV increased after ADT initiation. Higher VVHV was associated with an increased risk of MACEs.
In prostate cancer patients receiving androgen deprivation therapy (ADT), glycaemic control is less stable after initiating ADT, which was associated with an increased cardiovascular risk.
雄激素剥夺疗法（ADT）会使血糖控制和心血管结局恶化。在接受ADT的前列腺癌（PCa）患者中，就诊间糖化血红蛋白变异性（VVHV）的预后价值尚未得到探索。
探讨ADT对VVHV的影响以及VVHV的心血管预后价值。
设计、设置和参与者：本回顾性队列研究纳入了1993年1月1日至2021年3月31日期间在香港接受ADT的PCa患者。排除在ADT开始后3年内糖化血红蛋白结果少于3次、ADT时间<6个月、基线糖化血红蛋白缺失、既往有任何主要不良心血管事件（MACE）组成部分的诊断以及在3年内发生MACE的患者。对患者随访至2021年9月31日。
结局为MACE（心力衰竭、心肌梗死、中风和心血管死亡的复合事件）。使用变异系数（CV；标准差[SD]除以均值）和平均实际变异性（ARV；连续测量值之间的平均差异），根据ADT开始后3年内以及（如有）开始前的糖化血红蛋白水平计算VVHV。
共分析了1065例患者（中位年龄74.4岁[四分位间距68.3 - 79.5岁]）。在709例ADT开始前后均有VVHV数据的患者中，ADT开始后VVHV升高（<0.001），CV和ARV升高的患者分别有473例（66.2%）和474例（66.9%）。在中位随访4.3年（2.8 - 6.7年）期间，较高的VVHV与MACE风险较高相关（CV每增加1个SD的调整后风险比为1.21[95%置信区间：1.02, 1.43]，=0.029；ARV为1.25[1.06, 1.48]，=0.008）。局限性包括残余混杂和选择偏倚。
在接受ADT的PCa患者中，ADT开始后VVHV升高。较高的VVHV与MACE风险增加相关。
在接受雄激素剥夺疗法（ADT）的前列腺癌患者中，开始ADT后血糖控制稳定性降低，这与心血管风险增加相关。
