The Risk of Cardiovascular Disease in Prostate Cancer Patients Receiving Androgen Deprivation Therapies

• Published in: Epidemiology (Cambridge, Mass.) Vol. 31; no. 3; pp. 432 - 440
• Main Authors: Cardwell, Chris R., O’Sullivan, Joe M., Jain, Suneil, Harbinson, Mark T., Cook, Michael B., Hicks, Blánaid M., McMenamin, Úna C.
• Format: Journal Article
• Language: English
• Published: United States Wolters Kluwer Health, Inc. All rights reserved 01-05-2020; Copyright Wolters Kluwer Health, Inc. All rights reserved
• Subjects: Androgen Antagonists - adverse effects; Androgen Antagonists - therapeutic use; Cardiovascular Diseases - epidemiology; Humans; Male; Prostatic Neoplasms - drug therapy; Prostatic Neoplasms - epidemiology; Risk
• ISSN: 1044-3983; 1531-5487
• DOI: 10.1097/EDE.0000000000001132

BACKGROUND:Androgen deprivation therapy (ADT), with a proven role in prostate cancer management, has been associated with various cardiovascular diseases. However, few studies have investigated these associations by type of ADT, particularly for newer ADTs such as the gonadotropin-releasing hormone (GnRH) antagonist degarelix. We investigated the risk of cardiovascular disease by type of ADT in a real-world setting.
METHODS:We identified men newly diagnosed with prostate cancer, from 2009 to 2015, from the Scottish Cancer Registry and ADTs from the nationwide Prescribing Information System. Cardiovascular events were based upon hospitalization (from hospital records) or death from cardiovascular disease (from death records). We used Cox regression to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for cardiovascular events with time-varying ADT exposure, comparing ADT users with untreated patients, after adjusting for potential confounders, including prior cardiovascular disease.
RESULTS:The cohort contained 20,216 prostate cancer patients, followed for 73,570 person-years, during which there were 3,853 cardiovascular events. ADT was associated with a 30% increase in cardiovascular events (adjusted HR = 1.3; 95% CI = 1.2, 1.4). This reflected increases in cardiovascular events associated with GnRH agonists (adjusted HR = 1.3; 95% CI = 1.2, 1.4), degarelix (adjusted HR = 1.5; 95% CI = 1.2, 1.9), but not bicalutamide monotherapy (adjusted HR = 1.0; 95% CI = 0.82, 1.3).
CONCLUSIONS:There were increased risks of cardiovascular disease with the use of GnRH agonists and degarelix, but not with bicalutamide monotherapy. This is the first study to observe increased cardiovascular risks with degarelix, but the cause of this association is unclear and merits further investigation.