Cardiovascular Risk Profile in Prostate Cancer Patients Treated with GnRH Agonists versus Antagonists: An Italian Real-World Analysis

Figures & data

Figure 1 Flowchart of included patients.

Notes: Patients were defined ADT-naïve if they did not have a prescription for ADT in the 2 years before index date. Patients were defined ADT-experienced if they had at least one prescription for ADT in the 2 years before index date.

Abbreviations: AA, antiandrogens; ADT, androgen deprivation therapy; CV, cardiovascular; GnRH-a, gonadotropin-releasing hormone agonists; GnRH-ant, gonadotropin-releasing hormone antagonist; PCa, prostate cancer.

Table 1 Baseline Characteristics of Prostate Cancer Patients Treated with GnRH Agonists or Antagonists According to Type of Treatment

	Study Population	GnRH Agonists	GnRH Antagonist	P Value
Patients n (%)	9785 (100.0)	9158 (93.6)	627 (6.4)
Age (mean ± SD)	76.8 ± 8.5	76.9 ± 8.5	74.8 ± 8.2	<0.001
Age median (IQR)	78 (11)	78 (11)	76 (11)
Hypertension n (%)	6855 (70.1)	6423 (70.1)	432 (68.9)	0.513
Diabetes n (%)	1579 (16.1)	1483 (16.2)	96 (15.3)	0.561
Dyslipidemia n (%)	3170 (32.4)	2956 (32.3)	214 (34.1)	0.337
Cardiac therapy n (%)	1334 (13.6)	1249 (13.6)	85 (13.6)	0.954
Previous CV events n (%)	864 (8.8)	803 (8.8)	61 (9.7)	0.412
Follow-up period (mean years ± SD)	3.1 ± 1.5
Follow-up period median, (IQR)	3.3 (3.0)

Abbreviations: CV, cardiovascular; GnRH, gonadotropin-releasing hormone; IQR, interquartile; SD, standard deviation.

Table 2 Incidence Rate of CV Events in the Overall Cohort of Prostate Cancer Patients Treated with GnRH Agonists or Antagonists

	GnRH Agonist	GnRH Antagonist	P Value
Patients (n)	9097	530
Patients with CV events (n)	2206	76	<0.001
Overall number of CV events (n)	5478	170
Time to event (mean years ± SD)	1.6 ± 1.3	1.2 ± 1.1
Time to event (median, IQR)	1.3 (1.9)	1.0 (1.5)
Incidence rate/100 person-years	8.80	6.24	0.002

Abbreviations: CV, cardiovascular; GnRH, gonadotropin-releasing hormone; IQR, interquartile; SD, standard deviation.

Table 3 Incidence of CV Events in the Overall Cohort of Prostate Cancer Patients Treated with GnRH Agonists or Antagonists According to Characteristics at Baseline

	HR	95% CI min	95% CI max	P Value
Age	1.05	1.04	1.06	<0.001
Hypertension	1.57	1.40	1.75	<0.001
Diabetes	1.06	0.97	1.16	0.198
Dyslipidemia	1.63	1.39	1.91	<0.001
Cardiac therapy	1.58	1.42	1.75	<0.001
Previous CV events	3.27	2.75	3.89	<0.001
Treatment
GnRH agonists	1.00
GnRH antagonists	0.76	0.60	0.95	0.018

Abbreviations: CI, confidence interval; CV, cardiovascular; GnRH, gonadotropin-releasing hormone HR, hazard ratio.

Figure 2 Kaplan-Meier survival curves of incidence of CV events in GnRH agonists and antagonist-treated patients at 5 years considering (A) overall cohort, (B) sub-cohort of patients without previous CV events.

Abbreviations: CV, cardiovascular; GnRH-a, gonadotropin-releasing hormone agonists; GnRH-ant, gonadotropin-releasing hormone antagonist.

Table 4 Baseline Characteristics of Prostate Cancer Patients Treated with GnRH Agonists or Antagonists Without Previous CV Events According to Type of Treatment

	Study Population	GnRH Agonists	GnRH Antagonist	P Value
Patients n (%)	8921 (100.0)	8355 (93.7)	566 (6.3)
Age (mean ± SD)	76.6 ± 8.6	76.7 ± 8.6	74.8 ± 8.3	<0.001
Age median (IQR)	77 (10)	78 (11)	76 (10)
Hypertension n (%)	6061 (67.9)	5682 (68.0)	379 (67.0)	0.606
Diabetes n (%)	1333 (14.9)	1253 (15.0)	80 (14.1)	0.577
Dyslipidemia n (%)	2718 (30.5)	2536 (30.4)	182 (32.2)	0.367
Cardiac therapy n (%)	1047 (11.7)	981 (11.7)	66 (11.7)	0.954

Abbreviations: CV, cardiovascular; GnRH, gonadotropin-releasing hormone; IQR, interquartile; SD, standard deviation.

Table 5 Incidence Rate of CV Events in the Sub-Cohort of Prostate Cancer Patients Treated with GnRH Agonists or Antagonist Without Previous CV Events

	GnRH Agonists	GnRH Antagonist	P Value
Patients (n)	8300	474
Patients with CV events (n)	1845	60	<0.001
Overall number of CV events (n)	4245	140
Time to event (mean years ± SD)	1.7 ± 1.3	1.4 ± 1.1
Time to event median (IQR)	1.4 (2.0)	1.1 (1.5)
Incidence rate/100 person-years	7.83	5.33	0.002

Abbreviations: CV, cardiovascular; GnRH, gonadotropin-releasing hormone; IQR, interquartile; SD, standard deviation.

Table 6 Incidence of CV Events in the Sub-Cohort of Prostate Cancer Patients Treated with GnRH Agonists or Antagonists Without Previous CV Events According to Characteristics at Baseline

	HR	95% CI min	95% CI max	P value
Age	1.06	1.05	1.06	<0.001
Hypertension	1.55	1.38	1.73	<0.001
Diabetes	1.09	0.99	1.21	0.081
Dyslipidemia	1.48	1.32	1.66	<0.001
Cardiac therapy	1.59	1.41	1.79	<0.001
Treatment
GnRH agonists	1.00
GnRH antagonists	0.76	0.59	0.99	0.040

Abbreviations: CI, confidence interval; CV, cardiovascular; GnRH, gonadotropin-releasing hormone; HR, hazard ratio.