Attention: Restrictions on use of AUA, AUAER, and UCF content in third party applications, including artificial intelligence technologies, such as large language models and generative AI.
You are prohibited from using or uploading content you accessed through this website into external applications, bots, software, or websites, including those using artificial intelligence technologies and infrastructure, including deep learning, machine learning and large language models and generative AI.

JU INSIGHT Cardiovascular Risk in Prostate Cancer Patients

By: E. David Crawford, MD, University of California San Diego, Koman Family Outpatient Pavilion; Jason M. Hafron, MD, Michigan Institute of Urology, Troy; Frans Debruyne, MD, PhD, Andros Clinics, Arnhem, The Netherlands; Christopher Wallis, MD, PhD, University of Toronto, Ontario, Canada; Steven Chang, BA, Xelay Acumen Group, Inc, San Mateo, California; Marc B. Garnick, MD, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts | Posted on: 19 Jan 2024

Crawford ED, Hafron JM, Debruyne F, Wallis C, Chang S, Garnick MB. Cardiovascular risk in prostate cancer patients using luteinizing hormone-releasing hormone agonists or a gonadotropin-releasing hormone antagonist. J Urol. 2024;211(1):63-70.

Study Need and Importance

Androgen deprivation therapy (ADT) is the standard of care in advanced prostate cancer. Literature, as well as clinical experience, suggests cardiovascular (CV) risk is increased in men receiving ADT. Epidemiological data suggest an increased risk of CV events following initiation of both luteinizing hormone–releasing hormone (LHRH) agonist and gonadotropin-releasing hormone (GnRH) antagonist therapies, but these studies have been confounded by small patient populations, varying durations of follow-up, and inconsistent definitions of prior CV history. We used real-world clinical practice data to evaluate differences in major adverse CV events (MACE) risk between LHRH agonists compared to a GnRH antagonist following ADT initiation.

What We Found

The adjusted risk of MACE was higher for patients treated with the GnRH antagonist compared to LHRH agonists (HR = 1.62; 95% CI 1.21-2.18, P = .001; Figure). The demographic and risk factors with the greatest impact on MACE risk were age, baseline metastasis status, oncology (vs urology) setting, personal MACE history, antagonist (vs agonist), tobacco history, White (vs Black) race, and lower body mass index.

image
Figure. Major adverse cardiovascular events (MACE; urological) risk for patients treated with an antagonist vs agonists. ADT indicates androgen deprivation therapy; LHRH, luteinizing hormone–releasing hormone.

Limitations

The comparatively small number of patients treated with the GnRH antagonist may limit the generalizability of the results. There is a potential selection bias for GnRH antagonists in men with CV disease. The retrospective design means incomplete data in some patients, residual confounding may remain despite the use of rigorous statistical methods, and the results are hypothesis generating. Finally, our findings are based on a database that used ICD codes, thus the reliability is limited by the accuracy of coding practices.

Interpretation for Patient Care

As lifestyle and other risk factors inherent in patients with advanced prostate cancer on ADT contribute to increased risk of CV events, it is important that CV morbidity and mortality be reduced through appropriate assessment, monitoring, and treatment of the underlying CV diseases.

advertisement

advertisement