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Cardiovascular events associated with androgen deprivation therapy in patients with prostate cancer: a systematic review and meta-analysis

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Abstract

Context

A recently published meta-analysis of randomized clinical trials (RCT) showed that androgen deprivation therapy (ADT) did not significantly increase cardiovascular mortality in prostate cancer patients. However, cardiovascular morbidity, which can impact quality of life, was not evaluated.

Objective

To evaluate the risk of cardiovascular morbidity associated with ADT in patients with prostate cancer.

Methods

We conducted a literature search from January 1960 to June 2012. RCT and large cohort studies that evaluated first-line endocrine therapy and ADT longer than 6 months were screened for inclusion.

Results

In total, 126,898 patients were included in four cohort studies, and 10,760 patients were included in nine RCTs. Analysis of the RCTs showed no differences in the development of acute myocardial infarction (AMI) (OR 1.23; 95 % CI 0.92–1.64; I 2: 0 %) among the patients receiving ADT or not. The analysis of randomized studies that reported other nonfatal cardiovascular events demonstrated a significant increase in such events in the group receiving ADT (OR 1.55; 95 % CI 1.09–2.20; I 2: 0 %). When the large cohort studies were included in the analysis, an increased risk of AMI among men with ADT was found (OR 2.01, 95 % CI 1.90–2.13; I 2: 91,3 %).

Conclusion

The use of ADT in prostate cancer patients corresponded with a significant increase in cardiovascular morbidity associated with AMI and with nonfatal events. Therefore, ADT is linked to a significant negative impact on quality of life. Periodic cardiovascular evaluation is required for these patients.

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Authors and Affiliations

  1. Department of Urology, Faculdade de Medicina do ABC (ABC Medical School), Av. Príncipe de Gales, 821 - Príncipe de Gales, Santo André, São Paulo, SP, 09060-650, Brazil

    Arie Carneiro, Guilherme Peixoto, André Kataguiri, Ary Serpa Neto, Bianca Alves Vieira Bianco, Antônio Carlos Lima Pompeo & Marcos Tobias-Machado

  2. Department of Uro-oncology and Center of Oncologic Evidences, Universidade Estadual de Campinas, UNICAMP, Campinas, Brazil

    Andre Deeke Sasse

  3. Department of Surgery, Division of Urology, Beth Israel Deaconess Medical Center, Boston, MA, USA

    Andrew Aurel Wagner & Peter Chang

Authors
  1. Arie Carneiro
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  2. Andre Deeke Sasse
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  3. Andrew Aurel Wagner
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  9. Antônio Carlos Lima Pompeo
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  10. Marcos Tobias-Machado
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Correspondence to Arie Carneiro.

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Carneiro, A., Sasse, A.D., Wagner, A.A. et al. Cardiovascular events associated with androgen deprivation therapy in patients with prostate cancer: a systematic review and meta-analysis. World J Urol 33, 1281–1289 (2015). https://doi.org/10.1007/s00345-014-1439-6

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  • DOI: https://doi.org/10.1007/s00345-014-1439-6

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