TY - JOUR
T1 - Long-term prognostic impact of cardiovascular comorbidities in patients with prostate cancer receiving androgen deprivation therapy
T2 - A population-based competing risk analysis
AU - Chan, Jeffrey Shi Kai
AU - Lee, Yan Hiu Athena
AU - Hui, Jeremy Man Ho
AU - Liu, Kang
AU - Dee, Edward Christopher
AU - Ng, Kenrick
AU - Liu, Tong
AU - Tse, Gary
AU - Ng, Chi Fai
N1 - Publisher Copyright:
© 2023 The Authors. International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC.
PY - 2023/8/15
Y1 - 2023/8/15
N2 - Our study investigated how adverse cardiovascular outcomes are impacted by cardiovascular comorbidities in patients with prostate cancer treated by androgen deprivation therapy (ADT). Using prospective, population-based data, all Hong Kong patients with prostate cancer who received ADT during 1 January 1993 to 3 March 2021 were identified and followed up for the endpoint of cardiovascular hospitalization/mortality until 31 September 2021, whichever earlier. Multivariable competing risk regression was used to compare the endpoint's cumulative incidence between different combinations of major cardiovascular comorbidities (heart failure [HF], myocardial infarction [MI], stroke and/or arrhythmia), with noncardiovascular death as competing event. Altogether, 13 537 patients were included (median age 75.9 [interquartile range 70.0-81.5] years old; median follow-up 3.3 [1.5-6.7] years). Compared to those with none of prior HF/MI/stroke/arrhythmia, the incidence of the endpoint was not different in those with only stroke (subhazard ratio [SHR] 1.06 [95% confidence interval (CI): 0.92-1.23], P =.391), but was higher in those with only HF (SHR 1.67 [1.37-2.02], P <.001), arrhythmia (SHR 1.63 [1.35-1.98], P <.001) or MI (SHR 1.43 [1.14-1.79], P =.002). Those with ≥2 of HF/MI/stroke/arrhythmia had the highest incidence of the endpoint (SHR 1.94 [1.62-2.33], P <.001), among whom different major cardiovascular comorbidities had similar prognostic impacts, with the number of comorbidities present being significantly prognostic instead. In conclusion, in patients with prostate cancer receiving ADT, the sole presence of HF, MI or arrhythmia, but not stroke, may be associated with elevated cardiovascular risks. In those with ≥2 of HF/MI/stroke/arrhythmia, the number of major cardiovascular comorbidities may be prognostically more important than the type of comorbidities.
AB - Our study investigated how adverse cardiovascular outcomes are impacted by cardiovascular comorbidities in patients with prostate cancer treated by androgen deprivation therapy (ADT). Using prospective, population-based data, all Hong Kong patients with prostate cancer who received ADT during 1 January 1993 to 3 March 2021 were identified and followed up for the endpoint of cardiovascular hospitalization/mortality until 31 September 2021, whichever earlier. Multivariable competing risk regression was used to compare the endpoint's cumulative incidence between different combinations of major cardiovascular comorbidities (heart failure [HF], myocardial infarction [MI], stroke and/or arrhythmia), with noncardiovascular death as competing event. Altogether, 13 537 patients were included (median age 75.9 [interquartile range 70.0-81.5] years old; median follow-up 3.3 [1.5-6.7] years). Compared to those with none of prior HF/MI/stroke/arrhythmia, the incidence of the endpoint was not different in those with only stroke (subhazard ratio [SHR] 1.06 [95% confidence interval (CI): 0.92-1.23], P =.391), but was higher in those with only HF (SHR 1.67 [1.37-2.02], P <.001), arrhythmia (SHR 1.63 [1.35-1.98], P <.001) or MI (SHR 1.43 [1.14-1.79], P =.002). Those with ≥2 of HF/MI/stroke/arrhythmia had the highest incidence of the endpoint (SHR 1.94 [1.62-2.33], P <.001), among whom different major cardiovascular comorbidities had similar prognostic impacts, with the number of comorbidities present being significantly prognostic instead. In conclusion, in patients with prostate cancer receiving ADT, the sole presence of HF, MI or arrhythmia, but not stroke, may be associated with elevated cardiovascular risks. In those with ≥2 of HF/MI/stroke/arrhythmia, the number of major cardiovascular comorbidities may be prognostically more important than the type of comorbidities.
KW - androgen deprivation therapy
KW - cardio-oncology
KW - comorbidity
KW - hospitalization
KW - mortality
KW - prostate cancer
UR - http://www.scopus.com/inward/record.url?scp=85159153731&partnerID=8YFLogxK
U2 - 10.1002/ijc.34557
DO - 10.1002/ijc.34557
M3 - Article
C2 - 37183319
AN - SCOPUS:85159153731
SN - 0020-7136
VL - 153
SP - 756
EP - 764
JO - International Journal of Cancer
JF - International Journal of Cancer
IS - 4
ER -
