A recent systematic review and meta-analysis published in BMC Cardiovascular Disorders has shed new light on the relationship between androgen deprivation therapy (ADT) and heart failure risk in prostate cancer patients. The study, published in 2024, aimed to investigate whether ADT use increases the likelihood of developing heart failure in this patient population.
The meta-analysis included 9 cohort studies with a total of 189,045 prostate cancer patients. Studies were conducted across multiple countries, including the United States, Taiwan, Norway, South Korea, Canada, and China. The researchers searched PubMed, Scopus, and Google Scholar databases for relevant articles published up to February 2024.
Inclusion criteria for the meta-analysis required studies to be cohort designs that specifically examined the association between ADT and heart failure risk in prostate cancer patients. The researchers excluded animal studies, reviews, commentaries, and editorials. Patient demographics varied across studies, with mean/median ages ranging from 65 to 81 years old.
The primary finding of the meta-analysis was that ADT use was associated with a significantly increased risk of heart failure in prostate cancer patients. The overall pooled hazard ratio (HR) was 1.299 (95% CI: 1.003-1.595), indicating a 30% higher risk of heart failure among ADT users compared to non-users.
Interestingly, subgroup analyses revealed notable regional differences in the magnitude of this risk. In Asian populations, the pooled HR was 1.545 (95% CI: 1.180-1.910), suggesting a stronger association between ADT and heart failure risk. In contrast, the North American subgroup analysis yielded a pooled HR of 0.779 (95% CI: 0.421-1.138), indicating no significant increase in risk.
The study had several limitations that warrant consideration. There was significant heterogeneity observed across the included studies (I² = 92.5%), which could not be fully explained by the subgroup analyses. Additionally, publication bias was detected, particularly in the Asian subgroup, suggesting smaller studies with more extreme results may have been overrepresented.
The authors concluded that ADT use is associated with an increased risk of heart failure in prostate cancer patients, with the effect appearing more pronounced in Asian populations. They emphasized the need for cautious interpretation of the results given the heterogeneity and potential publication bias.
These findings have important potential clinical implications. For medical professionals treating prostate cancer patients, the results highlight the importance of carefully weighing the benefits and risks of ADT, particularly in patients with pre-existing cardiovascular risk factors. The study suggests that closer cardiovascular monitoring may be warranted for prostate cancer patients receiving ADT, especially those of Asian descent.
However, the regional differences observed in the meta-analysis also underscore the need for further research to better understand the factors influencing cardiovascular outcomes in different populations. The conflicting results between Asian and North American studies suggest that genetic, environmental, or healthcare-related factors may modulate the relationship between ADT and heart failure risk.
It is worth noting that the study did not differentiate between different types of ADT (e.g., GnRH agonists vs. antagonists) or treatment strategies (e.g., continuous vs. intermittent), which could potentially impact cardiovascular risk. Future studies addressing these nuances could provide valuable insights for optimizing prostate cancer treatment approaches.
In light of these findings, medical professionals may need to consider implementing more comprehensive cardiovascular risk assessments for prostate cancer patients prior to initiating ADT. For patients deemed at higher risk, alternative treatment strategies or more intensive cardiovascular monitoring during ADT may be appropriate.
The study also highlights the importance of a multidisciplinary approach to prostate cancer care, involving close collaboration between urologists, oncologists, and cardiologists. This collaborative model could help ensure that cardiovascular risks are adequately managed throughout the course of prostate cancer treatment.
While this meta-analysis provides valuable insights, it also underscores the need for large-scale, prospective studies to further elucidate the relationship between ADT and heart failure risk. Such studies could help identify specific patient subgroups at highest risk and inform the development of targeted interventions to mitigate cardiovascular complications in prostate cancer patients receiving hormonal therapy.
References
Khorram AA, Pourasgharian R, Shams AS, et al. Androgen deprivation therapy use and the risk of heart failure in patients with prostate cancer: a systematic review and meta-analysis. BMC Cardiovasc Disord. 2024;24(1):756. Published 2024 Dec 30. doi:10.1186/s12872-024-04421-w
