Full Paper

British Journal of Cancer advance online publication 24 August 2017; doi: 10.1038/bjc.2017.280

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

Reina Haque1, Marianne UlcickasYood2, Xiaoqing Xu1, Andrea E Cassidy-Bushrow3, Huei-Ting Tsai4, Nancy L Keating5,6, Stephen K Van Den Eeden7 and Arnold L Potosky4

  1. 1Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA 91101, USA
  2. 2Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
  3. 3Henry Ford Health Systems, Detroit, MI 484202, USA
  4. 4Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
  5. 5Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA
  6. 6Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA
  7. 7Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612, USA

Correspondence: Dr R Haque, E-mail: Reina.Haque@kp.org

Received 14 March 2017; Revised 6 July 2017; Accepted 24 July 2017
Advance online publication 24 August 2017

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Abstract

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.

Keywords:

cardiovascular disease; prostate cancer; androgen deprivation therapy