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The cardiovascular effects of gonadotropin-releasing hormone antagonists in men with prostate cancer.

  • Cirne, Filipe1
  • Aghel, Nazanin1
  • Petropoulos, Jo-Anne2
  • Klotz, Laurence3
  • Lenihan, Daniel J4
  • Saad, Fred5
  • Pinthus, Jehonathan6
  • Leong, Darryl P1, 7, 8
  • 1 Department of Medicine, McMaster University and Hamilton Health Sciences, 1280 Main St West, Hamilton, ON, L8S 4L8, Canada. , (Canada)
  • 2 Health Sciences Library, McMaster University, 1280 Main St West, Hamilton, ON, L8S 4L8, Canada. , (Canada)
  • 3 Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada. , (Canada)
  • 4 Cardio-Oncology Center of Excellence, Washington University in St. Louis, 660 South Euclid, St. Louis, MO, 63110, USA.
  • 5 University of Montreal Hospital Center, 900 Rue St. Denis, Montreal, Quebec, H2X 0A9, Canada. , (Canada)
  • 6 Department of Surgery, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada. , (Canada)
  • 7 Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada. , (Canada)
  • 8 The Population Health Research Institute, McMaster University and Hamilton Health Sciences, 237 Barton St. East, Hamilton, ON, L8L 2X2, Canada. , (Canada)
Published Article
European heart journal. Cardiovascular pharmacotherapy
Publication Date
May 05, 2022
DOI: 10.1093/ehjcvp/pvab005
PMID: 33470403


The aim of this study was to determine whether gonadotropin-releasing hormone (GnRH) antagonists (an emerging class of drugs to suppress testosterone synthesis in the treatment of prostate cancer) cause less adverse cardiovascular events than the more commonly use GnRH agonists. We conducted a systematic review to identify all randomized, controlled trials in which a GnRH antagonist was compared with a GnRH agonist in men with prostate cancer. We identified 10 eligible studies including two different GnRH antagonists, degarelix (n = 1681) and relugolix (n = 734), which were compared with the GnRH agonists, leuprolide (n = 714) and goserelin (n = 600). The pooled risk ratios (95% confidence intervals) among GnRH antagonist recipients for adverse cardiovascular events, cardiovascular death, and all-cause mortality were 0.57 (0.39-0.81); 0.49 (0.25-0.96); and 0.48 (0.28-0.83), respectively. Important limitations of the included trials were their short duration of follow-up, unblinded study design and (in most of the studies) the identification of adverse cardiovascular events through safety reporting mechanisms rather than as a pre-specified outcome. There was no evidence of heterogeneity of findings among the studies. There is consistent but methodologically limited data to suggest that GnRH antagonists-a relatively new class of androgen deprivation therapy for prostate cancer-cause significantly less cardiovascular adverse effects than the more frequently used GnRH agonists. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021.

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