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Cardiovascular disease risk and androgen deprivation therapy in patients with localised prostate cancer: a prospective cohort study

机译:局部前列腺癌患者的心血管疾病风险和雄激素剥夺治疗:一项前瞻性队列研究

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Background: As androgen deprivation therapy (ADT) is increasingly being used in men with localised prostate cancer, our goal was to examine the association between ADT and the risk of cardiovascular disease (CVD). Methods: We conducted a prospective cohort study using records of a large health-care system in California. The study included men with newly diagnosed localised prostate cancer (1998–2008) who initially underwent active surveillance ( N =7637) and were followed through 2010. We examined 10 individual CVD outcomes. Cox proportional hazard models incorporated time-varying treatment variables and controlled for race/ethnicity, age, and tumour characteristics, recurrence risk, CVD medication use, and CVD risk factors. Results: Of the 7637 subjects, nearly 30% were exposed to ADT. In the multivariable analyses, ADT was associated with an increased risk of heart failure (adjusted HR=1.81, 95% CI 1.40–2.32) in men without preexisting CVD. Elevated risks of arrhythmia (adjusted HR=1.44, 95% CI 1.02–2.01), and conduction disorder (adjusted HR=3.11, 95% CI 1.22, 7.91) were only observed among patients with preexisting CVD. Conclusions: In men with clinically localised prostate cancer who were initially under active surveillance, ADT was associated with a greater risk of heart failure in men without any preexisting CVD. We also found an increased risk of arrhythmia and conduction disorder in men with preexisting CVD. This study provides the basis for identifying high-risk men treated with ADT who might benefit from regular cardiac monitoring and lifestyle modification recommendations.
机译:背景:随着雄激素剥夺疗法(ADT)越来越多地用于局部前列腺癌的男性中,我们的目标是检查ADT与心血管疾病(CVD)风险之间的关联。方法:我们使用加利福尼亚大型卫生保健系统的记录进行了前瞻性队列研究。该研究纳入了刚诊断为局部前列腺癌的男性(1998-2008年),他们最初接受了主动监测(N = 7637),并一直随访到2010年。我们检查了10个人的CVD结果。 Cox比例风险模型结合了随时间变化的治疗变量,并控制种族/种族,年龄和肿瘤特征,复发风险,CVD药物使用和CVD风险因素。结果:在7637名受试者中,近30%的受试者接受了ADT。在多变量分析中,ADT与未患有CVD的男性心力衰竭风险增加(校正后的HR = 1.81,95%CI 1.40–2.32)有关。心律失常的风险升高(调整后的HR = 1.44,95%CI 1.02–2.01)和传导障碍(调整后的HR = 3.11,95%CI 1.22,7.91)仅在已有CVD的患者中观察到。结论:在最初接受主动监测的临床上局部前列腺癌的男性中,ADT与没有任何CVD的男性发生心力衰竭的风险较高相关。我们还发现患有CVD的男性患心律失常和传导障碍的风险增加。这项研究为确定接受ADT治疗的高危男性提供了基础,这些男性可能会从常规的心脏监测和生活方式改变建议中受益。

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