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J Clin Oncol. 2015 Apr 10;33(11):1243-51. doi: 10.1200/JCO.2014.59.1792. Epub 2015 Mar 2.

Risk and timing of cardiovascular disease after androgen-deprivation therapy in men with prostate cancer.

Author information

1
Sean O'Farrell, Hans Garmo, Lars Holmberg, and Mieke Van Hemelrijck, King's College London, School of Medicine; Sean O'Farrell, Guy's and St Thomas' National Health Service Foundation Trust and King's College London's Comprehensive Biomedical Research Centre, London, United Kingdom; Hans Garmo and Lars Holmberg, Regional Cancer Centre, Uppsala Örebro; Lars Holmberg, Uppsala University, Uppsala; Jan Adolfsson and Mieke Van Hemelrijck, Karolinska Institutet, Stockholm; and Pär Stattin, Umeå University, Umeå, Sweden. sean.o'farrell@kcl.ac.uk.
2
Sean O'Farrell, Hans Garmo, Lars Holmberg, and Mieke Van Hemelrijck, King's College London, School of Medicine; Sean O'Farrell, Guy's and St Thomas' National Health Service Foundation Trust and King's College London's Comprehensive Biomedical Research Centre, London, United Kingdom; Hans Garmo and Lars Holmberg, Regional Cancer Centre, Uppsala Örebro; Lars Holmberg, Uppsala University, Uppsala; Jan Adolfsson and Mieke Van Hemelrijck, Karolinska Institutet, Stockholm; and Pär Stattin, Umeå University, Umeå, Sweden.

Abstract

PURPOSE:

Findings on the association between risk of cardiovascular disease (CVD) and the duration and type of androgen-deprivation therapy (ADT) in men with prostate cancer (PCa) are inconsistent.

METHODS:

By using data on filled drug prescriptions in Swedish national health care registers, we investigated the risk of CVD in a cohort of 41,362 men with PCa on ADT compared with an age-matched, PCa-free comparison cohort (n = 187,785) by use of multivariable Cox proportional hazards regression models.

RESULTS:

From 2006 to 2012, 10,656 men were on antiandrogens (AA), 26,959 were on gonadotropin-releasing hormone (GnRH) agonists, and 3,747 underwent surgical orchiectomy. CVD risk was increased in men on GnRH agonists compared with the comparison cohort (hazard ratio [HR] of incident CVD, 1.21; 95% CI, 1.18 to 1.25; and orchiectomy: HR, 1.16; 95% CI, 1.08 to 1.25). Men with PCa on AA were at decreased risk (HR of incident CVD, 0.87; 95% CI, 0.82 to 0.91). CVD risk was highest during the first 6 months of ADT in men who experienced two or more cardiovascular events before therapy, with an HR of CVD during the first 6 months of GnRH agonist therapy of 1.91 (95% CI, 1.66 to 2.20), an HR of CVD with AA of 1.60 (95% CI, 1.24 to 2.06), and an HR of CVD with orchiectomy of 1.79 (95% CI, 1.16 to 2.76) versus the comparison cohort.

CONCLUSION:

Our results support that there should be a solid indication for ADT in men with PCa so that benefit outweighs potential harm; this is of particular importance among men with a recent history of CVD.

PMID:
25732167
DOI:
10.1200/JCO.2014.59.1792
[Indexed for MEDLINE]

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