Cardiovascular Risk in Prostate Cancer Patients Using Luteinizing Hormone–Releasing Hormone Agonists or a Gonadotropin-Releasing Hormone Antagonist

Open AccessJournal of UrologyAdult Urology5 Oct 2023Cardiovascular Risk in Prostate Cancer Patients Using Luteinizing Hormone-Releasing Hormone Agonists or a Gonadotropin-Releasing Hormone Antagonist E. David Crawford, Jason M. Hafron, Frans Debruyne, Christopher Wallis, Steven Chang, and Marc B. Garnick E. David CrawfordE. David Crawford *Correspondence: Urology, Jack A Vickers Director of Prostate Research, University of California San Diego, Koman Family Outpatient Pavilion, 9400 Campus Point Dr., La Jolla, CA 92037 (telephone: (303) 668-8393; Email: E-mail Address: [email protected]). University of California San Diego, Koman Family Outpatient Pavilion, San Diego, California More articles by this author , Jason M. HafronJason M. Hafron Michigan Institute of Urology, Troy, Michigan More articles by this author , Frans DebruyneFrans Debruyne Andros Clinics, Arnhem, The Netherlands More articles by this author , Christopher WallisChristopher Wallis University of Toronto, Toronto, Ontario, Canada More articles by this author , Steven ChangSteven Chang Xelay Acumen Group, Inc., San Mateo, California More articles by this author , and Marc B. GarnickMarc B. Garnick Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003721AboutPDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookLinked InTwitterEmail Abstract Purpose: LHRH agonists are believed to have higher cardiovascular risk relative to GnRH antagonists. However, previous studies have not consistently demonstrated this. We used real-world clinical practice data to evaluate differences in MACE risk between LHRH agonists compared to a GnRH antagonist following androgen deprivation therapy (ADT) initiation. Materials and Methods: We performed a retrospective analysis of data in the Decision Resources Group (now Clarivate) Real World Evidence repository, which represents >300 million US patients from 1991-2020 across all US regions. Patients with prostate cancer (PCa) who received at least 1 injection of ADT were included. The risks of MACE and all-cause mortality as independent endpoints were evaluated, Kaplan-Meier curves were constructed, and associations between MACE and all available confounding risk factors were evaluated by Cox regression analysis using Statistical Package for the Social Sciences (SPSS). Results: A total of 45,059 men with PCa treated with ADT were analyzed. Overall, the risks of MACE and all-cause mortality were slightly lower in the first year after ADT initiation compared to subsequent years. MACE risk was higher for the GnRH antagonist compared to LHRH agonists (HR = 1.62; 95% CI 1.21-2.18, P = .001). The risk of all-cause mortality was also higher for the GnRH antagonist vs LHRH agonists (HR = 1.87; 95% CI 1.39-2.52, P < .001). Conclusions: The adjusted incidence of MACE was higher for men treated with the GnRH antagonist compared to the LHRH agonists. The demographic and risk factors with the greatest impact on MACE risk were higher age, baseline metastasis, oncology (vs urology) setting, personal MACE history, antagonist (vs agonist), tobacco history, White (vs Black) race, and lower BMI. This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.© 2023 The Author(s). Published on behalf of the American Urological Association, Education and Research, Inc.FiguresReferencesRelatedDetails Supplementary Materials Advertisement Copyright & Permissions© 2023 The Author(s). Published on behalf of the American Urological Association, Education and Research, Inc.Keywordsmajor adverse cardiovascular events (MACE)GnRH antagonistLHRH agonistprostate cancercardiovascular riskMetrics Author Information E. David Crawford University of California San Diego, Koman Family Outpatient Pavilion, San Diego, California *Correspondence: Urology, Jack A Vickers Director of Prostate Research, University of California San Diego, Koman Family Outpatient Pavilion, 9400 Campus Point Dr., La Jolla, CA 92037 (telephone: (303) 668-8393; Email: E-mail Address: [email protected]). More articles by this author Jason M. Hafron Michigan Institute of Urology, Troy, Michigan More articles by this author Frans Debruyne Andros Clinics, Arnhem, The Netherlands More articles by this author Christopher Wallis University of Toronto, Toronto, Ontario, Canada More articles by this author Steven Chang Xelay Acumen Group, Inc., San Mateo, California More articles by this author Marc B. Garnick Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts More articles by this author Expand All Advertisement PDF downloadLoading ...