Cardio-Oncology Research Unit, Cardiovascular Analytics Group, Hong Kong-United Kingdom-China collaboration, Hong Kong, China.
Division of Urology, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
Br J Cancer. 2023 Jun;128(12):2253-2260. doi: 10.1038/s41416-023-02271-5. Epub 2023 Apr 19.
Although androgen deprivation therapy (ADT) is associated with cardiovascular risks, the extent and temporal trends of cardiovascular burden amongst patients with prostate cancer receiving ADT are unclear.
This retrospective cohort study analyzed adults with PCa receiving ADT between 1993-2021 in Hong Kong, with follow-up until 31/9/2021 for the primary outcome of major adverse cardiovascular events (MACE; composite of cardiovascular mortality, myocardial infarction, stroke, and heart failure), and the secondary outcome of mortality. Patients were stratified into four groups by the year of ADT initiation for comparisons.
Altogether, 13,537 patients were included (mean age 75.5 ± 8.5 years old; mean follow-up 4.7 ± 4.3 years). More recent recipients of ADT had more cardiovascular risk factors and used more cardiovascular or antidiabetic medications. More recent recipients of ADT had higher risk of MACE (most recent (2015-2021) vs least recent (1993-2000) group: hazard ratio 1.33 [1.11, 1.59], P = 0.002; P < 0.001), but lower risk of mortality (hazard ratio 0.76 [0.70, 0.83], P < 0.001; P < 0.001). The 5-year risk of MACE and mortality for the most recent group were 22.5% [20.9%, 24.2%] and 52.9% [51.3%, 54.6%], respectively.
Cardiovascular risk factors were increasingly prevalent amongst patients with prostate cancer receiving ADT, with increasing risk of MACE despite decreasing mortality.
尽管雄激素剥夺疗法（ADT）与心血管风险相关，但接受 ADT 的前列腺癌患者的心血管负担程度和时间趋势尚不清楚。
本回顾性队列研究分析了 1993 年至 2021 年期间在香港接受 ADT 的前列腺癌患者，主要结局为主要不良心血管事件（MACE；心血管死亡率、心肌梗死、卒中和心力衰竭的综合），次要结局为死亡率，随访至 2021 年 9 月 31 日。根据 ADT 开始的年份，将患者分为四组进行比较。
共纳入 13537 例患者（平均年龄 75.5±8.5 岁；平均随访 4.7±4.3 年）。最近接受 ADT 的患者有更多的心血管危险因素，使用更多的心血管或抗糖尿病药物。最近接受 ADT 的患者发生 MACE 的风险更高（最近（2015-2021 年）与最不最近（1993-2000 年）组：风险比 1.33[1.11，1.59]，P=0.002；P<0.001），但死亡率风险较低（风险比 0.76[0.70，0.83]，P<0.001；P<0.001）。最近一组的 MACE 和死亡率的 5 年风险分别为 22.5%[20.9%，24.2%]和 52.9%[51.3%，54.6%]。
接受 ADT 的前列腺癌患者的心血管危险因素越来越普遍，尽管死亡率下降，但 MACE 的风险增加。
