Association between medical androgen deprivation therapy and long‐term cardiovascular disease and all‐cause mortality in nonmetastatic prostate cancer. Issue 7 (17th May 2022)

• Record Type: Journal Article
• Authors: Forster, Rachel B.; Engeland, Anders; Kvåle, Rune; Hjellvik, Vidar; Bjørge, Tone
• Is Part Of: International journal of cancer. Volume 151:Issue 7(2022)
• Page Start: 1109
• Page End: 1119
• Publication Date: 2022-05-17
• Subjects: androgen deprivation therapy -- cardiovascular disease -- epidemiology -- prostate cancer; Cancer -- Periodicals; Cancer -- Prevention -- Periodicals; 616.994
• DOI: 10.1002/ijc.34058
• Languages: English
• ISSNs: 0020-7136

Abstract

Abstract: Studies have suggested that prostate cancer (PCa) patients receiving androgen deprivation therapy (ADT) are at increased risk of developing or exacerbating cardiovascular disease (CVD). We aimed to explore the association between ADT for PCa and subsequent CVD and all‐cause mortality in this nationwide, longitudinal study. We also evaluated the role of cardiovascular risk and ADT duration to determine effect modification. Norwegian registry data were used to identify patients with PCa from 2008‐18 and who received primary ADT in the first year after diagnosis. The associations between ADT and composite cardiovascular events, and the individual components of myocardial infarction, stroke and heart failure, in addition to atrial fibrillation and all‐cause mortality, were explored using time‐varying Cox regression models. We included 30 923 PCa patients, of whom 8449 (27%) received primary ADT. Mean follow‐up was 2.9 and 3.8 years for CVD events and mortality, respectively. We found an association between ADT and composite CVD (adjusted HR 1.13: 95% CI 1.05‐1.21), myocardial infarction (1.18: 1.05‐1.32), stroke (1.21: 1.06‐1.38), heart failure (1.23: 1.13‐1.35) and all‐cause mortality (1.49: 1.39‐1.61). These associations persisted in those with low and moderate CVD risk and ADT longer than 7 months. A relationship between ADT and composite CVD and all‐cause mortality was observed, especially in those with moderate CVD risk and longer treatment duration. Future studies with more detailed cancer data are needed to verify the clinical relevance of these results, especially when considering all‐cause mortality within the context of treatment guidelines and benefits of ADT. Abstract : What's new? Existing evidence suggests that prostate cancer patients receiving androgen deprivation therapy are at increased risk of cardiovascular disease. The relationship between prostate cancer treatment and cardiovascular disease remains unclear, however. Using longitudinal registry data for all prostate cancer patients in Norway, our study identifies an increased risk of cardiovascular disease and mortality in patients treated with androgen deprivation therapy. The increased risk is most pronounced in patients with low or moderate prior risk of cardiovascular disease and longer duration of treatment. The findings contribute new evidence to the ongoing discussion about the use of hormonal therapy.