The impact of androgen‐deprivation therapy (ADT) on the risk of cardiovascular (CV) events in patients with non‐metastatic prostate cancer: a population‐based study

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Abstract
Objective To examine and quantify the contemporary association between androgen‐deprivation therapy (ADT) and three separate endpoints: coronary artery disease (CAD), acute myocardial infarction (AMI), and sudden cardiac death (SCD), in a large USA contemporary cohort of patients with prostate cancer. Patients and Methods In all, 140 474 patients diagnosed with non‐metastatic prostate cancer between 1995 and 2009 within the Surveillance, Epidemiology, and End Results (SEER)‐Medicare linked database were abstracted. Patients treated with ADT and those not receiving ADT were matched using propensity score methodology. The 10‐year CAD, AMI, and SCD rates were estimated. Competing‐risks regression analyses tested the association between the type of ADT (GnRH agonists vs bilateral orchidectomy) and CAD, AMI, and SCD, after adjusting for the risk of dying during follow‐up. Results Overall, the 10‐year rates of CAD, AMI, and SCD were 25.9%, 15.6%, and 15.8%, respectively. After stratification according to ADT status (ADT‐naïve vs GnRH agonists vs bilateral orchidectomy), the CAD rates were 25.1% vs 26.9% vs 23.2%, the AMI rates were 14.8% vs 16.6% vs 14.8%, and the SCD rates were 14.2% vs 17.7% vs 16.4%, respectively. In competing‐risks multivariable regression analyses, the administration of GnRH agonists (all P < 0.001), but not bilateral orchidectomy (all P ≥ 0.7), was associated with higher risk of CAD, AMI, and SCD. Conclusions The administration of GnRH agonists, but not orchidectomy, is still associated with a significantly increased risk of CAD, AMI, and, especially, SCD in patients with non‐metastatic prostate cancer. Alternative forms of ADT should be considered in patients at higher risk of CV events.