Introduction

Androgen receptor targeted agents (ARTA) have increasingly been incorporated into treatment regimens for various stages of prostate cancer. Patients are living longer with prostate cancer, and thus have a higher cumulative exposure to the treatment and its accompanying side effects, especially those of cardiovascular disease. We aim to assess the differences in the incidence of cardiac-related adverse events after treatment of prostate cancer with ARTA versus placebo.

Methods

Three databases were thoroughly searched for relevant articles. The PICOS model was used to frame our clinical question, with which 2 independent authors went through several rounds of screening to select the final included studies. Meta-analysis was done using the Cochran-Mantel-Haenszel Method. Quality assessment was carried out with the Cochrane Risk of Bias tool RoB 2.

Results

The use of ARTA in prostate cancer increases the incidence of cardiac-related adverse events (RR: 1.56, 95% CI: 1.29–1.90, p < 0.00001), such as hypertension (RR: 1.69, 95% CI: 1.46–1.97, p < 0.00001), ischaemic heart disease (RR: 1.84, 95% CI: 1.36–2.50, p < 0.0001), and arrhythmia (RR: 1.38, 95% CI: 1.11–1.71, p = 0.004), although this did not manifest in an increased incidence of cardiac arrests/deaths (RR: 1.28, 95% CI: 0.87–1.88, p = 0.21).

Discussion

ARTA increases the risk of cardiac-related adverse events, hypertension, ischaemic heart disease and arrhythmia. Armed with this knowledge, we will be better poised to manage cardiac risks accordingly and involve a cardiologist as required when starting patients on ARTA.

中文翻译：

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前列腺癌中雄激素受体靶向药物的心血管风险：系统评价和荟萃分析

介绍

雄激素受体靶向药物（ARTA）已越来越多地被纳入前列腺癌各个阶段的治疗方案中。前列腺癌患者的寿命更长，因此对治疗及其伴随副作用（尤其是心血管疾病）的累积暴露程度更高。我们的目的是评估 ARTA 与安慰剂治疗前列腺癌后心脏相关不良事件发生率的差异。

方法

彻底搜索了三个数据库以查找相关文章。PICOS 模型用于构建我们的临床问题，两位独立作者通过多轮筛选来选择最终纳入的研究。使用 Cochran-Mantel-Haenszel 方法进行荟萃分析。使用 Cochrane 偏差风险工具 RoB 2 进行质量评估。

结果

在前列腺癌中使用 ARTA 会增加心脏相关不良事件的发生率（RR：1.56，95% CI：1.29–1.90，p  < 0.00001），例如高血压（RR：1.69，95% CI：1.46–1.97，p  < 0.00001）、缺血性心脏病（RR：1.84，95% CI：1.36–2.50，p  < 0.0001）和心律失常（RR：1.38，95% CI：1.11–1.71，p  = 0.004），尽管这并没有影响表现为心脏骤停/死亡发生率增加（RR：1.28，95% CI：0.87-1.88，p  = 0.21）。

讨论

ARTA 会增加心脏相关不良事件、高血压、缺血性心脏病和心律失常的风险。有了这些知识，我们将能够更好地相应地管理心脏风险，并在开始患者接受 ARTA 治疗时根据需要邀请心脏病专家参与。