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


CONCLUSIONS
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.
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@yahoo.com.br.
Arie
A
Carneiro
Andre Deeke
AD
Sasse
Andrew Aurel
AA
Wagner
Guilherme
G
Peixoto
André
A
Kataguiri
Ary Serpa
AS
Neto
Bianca Alves Vieira
BA
Bianco
Peter
P
Chang
Antônio Carlos Lima
AC
Pompeo
Marcos
M
Tobias-Machado
D000726:Androgen Antagonists / Q000009:adverse effects* / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000139:chemically induced* / Q000453:epidemiology*; D002423:Cause of Death / Q000639:trends; D014943:Global Health; D006801:Humans; D008297:Male; D009017:Morbidity / Q000639:trends; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000401:mortality; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends
D000726:Androgen Antagonists