Is Androgen Deprivation Therapy for Prostate Cancer Associated with Cardiovascular disease ? A Meta-Analysis and systematic review.

Whether androgen deprivation therapy (ADT) is associated with an increased risk of developing cardiovascular related disease is poorly defined. The aim of the present meta-analysis is to explore the relationship between ADT and the risk of cardiac events.

For this systematic review and meta-analysis, we searched databases from inception to April 2019 for randomized controlled trials (RCT) or observational studies that reported data on ADT administration and cardiac events incidence. The connection was evaluated through estimating relative risk ratio (RR) and 95% confidence intervals (CIs).

A significantly increased acute myocardial infarction (AMI) was detected in ADT group compared with control group; (RR = 1.19; 95% confidence interval CI, 1.02-1.39; P < .05). Significant difference between cardiovascular disease (CVD) and ADT was also observed, with summary RR = 1.25; 95% CI, 1.11-1.40; P < .05. Furthermore, our study also suggested ADT was not related to increased incidence of sudden cardiac death (SCD). (RR = 1.13; 95% CI, 0.92-1.38; P = .24); AMI and CVD were not connected with the duration of ADT. (AMI: RR = 1.31, 95%CI, 0.66-2.63, P = .44 for > 5 year group; CVD: RR = 1.12, 95% CI, 0.97-1.30; P = .12 for > 5 year group). In addition, the RR for risk of CVD was 1.28 (95% CI, 1.01-1.62 P < .05) for men with PCa on new hormonal agents.

Pooled result demonstrated that ADT could significantly increase the risk of CVD and AMI, but not SCD. Various ADT modalities have different impact on cardiovascular disease risk in different level. Our meta-analysis also indicated that the long-term application of ADT is not associated with increased risk of AMI and CVD. Abiraterone and enzalutamide could significantly increase the incidence of cardiac events in patients who suffered from prostate cancer.

Andrology. 2019 Nov 19 [Epub ahead of print]

Zhen Liang, Jun Zhu, Longlong Chen, Yawei Xu, Yongjiao Yang, Rui Hu, Wei Zhang, Yuxuan Song, Yi Lu, Ningjing Ou, Xiaoqiang Liu

Tianjin Medical University General Hospital Urology Department Tianjin People's Republic of China., Second Hospital Tianjin Medical University Urology Department Tianjin People's Republic of China.