Association between duration of gonadotrophin-releasing hormone agonist use and cardiovascular risks: A population-based competing-risk analysis

Jeffrey S K Chan, Pias Tang, Jeremy M Ho Hui, Yan H A Lee, Edward C Dee, Kenrick Ng, Kang Liu, Gary Tse, Chi Fai Ng, Jeffrey S K Chan, Pias Tang, Jeremy M Ho Hui, Yan H A Lee, Edward C Dee, Kenrick Ng, Kang Liu, Gary Tse, Chi Fai Ng

Abstract

Background: Although androgen deprivation therapy has known cardiovascular risks, it is unclear if its duration is related to cardiovascular risks. This study thus aimed to investigate the associations between gonadotrophin-releasing hormone (GnRH) agonist use duration and cardiovascular risks.

Methods: This retrospective cohort study included adult patients with prostate cancer receiving GnRH agonists in Hong Kong during 1999-2021. Patients who switched to GnRH antagonists, underwent bilateral orchidectomy, had <6 months of GnRH agonist, prior myocardial infarction (MI), or prior stroke was excluded. All patients were followed up until September 2021 for a composite endpoint of MI and stroke. Multivariable competing-risk regression using the Fine-Gray subdistribution model was used, with mortality from any cause as the competing event.

Results: In total, 4038 patients were analyzed (median age 74.9 years old, interquartile range (IQR) 68.7-80.8 years old). Over a median follow-up of 4.1 years (IQR 2.1-7.5 years), longer GnRH agonists use was associated with higher risk of the endpoint (sub-hazard ratio per year 1.04 [1.01-1.06], p = 0.001), with those using GnRH agonists for ≥2 years having an estimated 23% increase in the sub-hazard of the endpoint (sub-hazard ratio 1.23 [1.04-1.46], p = 0.017).

Conclusion: Longer GnRH agonist use may be associated with greater cardiovascular risks.

Keywords: androgen deprivation therapy; cardio-oncology; cohort; prostate cancer.

Conflict of interest statement

The authors declare no conflict of interest.

© 2022 The Authors. The Prostate published by Wiley Periodicals LLC.

Figures

Figure 1
Figure 1
Cumulative sub‐hazard curve showing that patients with ≥2 years of gonadotrophin‐releasing hormone (GnRH) agonist use had significantly higher risk of the endpoint than those with p = 0.017). [Color figure can be viewed at wileyonlinelibrary.com]

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