Association of androgen deprivation therapy with cardiovascular death in patients with prostate cancer: A meta-analysis of randomized trials
JAMA, 12/07/2011
Clinical Article
Nguyen PL et al. – In a pooled analysis of randomized trials in unfavorable–risk prostate cancer, ADT use was not associated with an increased risk of cardiovascular death but was associated with a lower risk of PCSM and all–cause mortality.
Methods- Search of MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials databases for relevant randomized controlled trials in English between January 1, 1966, and April 11, 2011
- Inclusion required nonmetastatic disease, intervention group with gonadotropin–releasing hormone agonist–based ADT, control group with no immediate ADT, complete information on cardiovascular deaths, and median follow–up of more than 1 year
- Data Extraction Extraction was by 2 independent reviewers
- Summary incidence, relative risk (RR), and CIs calculated using random–effects or fixed–effects models
- Among 4141 patients from 8 randomized trials, cardiovascular death in patients receiving ADT vs control was not significantly different (255/2200 vs 252/1941 events; incidence, 11.0%; 95% CI, 8.3%–14.5%; vs 11.2%; 95% CI, 8.3%–15.0%; RR, 0.93; 95% CI, 0.79–1.10; P = .41)
- ADT was not associated with excess cardiovascular death in trials of at least 3 years (long duration) of ADT (11.5%; 95% CI, 8.1%–16.0%; vs 11.5%; 95% CI, 7.5%–17.3%; RR, 0.91; 95% CI, 0.75–1.10; P = .34) or in trials of 6 months or less (short duration) of ADT (10.5%; 95% CI, 6.3%–17.0%; vs 10.3%; 95% CI, 8.2%–13.0%; RR, 1.00; 95% CI, 0.73–1.37; P = .99)
- Among 4805 patients from 11 trials with overall death data, ADT was associated with lower PCSM (443/2527 vs 552/2278 events; 13.5%; 95% CI, 8.8%–20.3%; vs 22.1%; 95% CI, 15.1%–31.1%; RR, 0.69; 95% CI, 0.56–0.84; P < .001) and lower all–cause mortality (1140/2527 vs 1213/2278 events; 37.7%; 95% CI, 27.3%–49.4%; vs 44.4%; 95% CI, 32.5%–57.0%; RR, 0.86; 95% CI, 0.80–0.93; P < .001)
