Cardiovascular risks of Asian patients on androgen-receptor-targeted agents for prostate cancer: a systematic review and meta-analysis

Prostate cancer is now one of the most prevalent cancers in men in Asia. As the average life expectancy of Asian males with prostate cancer increases with the availability of treatment options, the possible risk of cardiac-related adverse effects arising from androgen-receptor-targeted agents (ARTAs) may be increased due to the greater exposure. We aim to perform a meta-analysis on the incidence of cardiac-related adverse events in Asian patients with prostate cancer treated with ARTAs. Databases were thoroughly searched for relevant articles. The Patient Intervention Comparison Outcome Study type model was used to frame our clinical question, and 2 independent authors went through several rounds of screening to select the final included studies. A meta-analysis was conducted using the Cochran–Mantel–Haenszel method. Quality assessment was carried out with the Cochrane risk-of-bias tool RoB 2. Seven randomized controlled trials were included for the final meta-analysis. Use of ARTA in Asian men did not show any significant increase in the total number of cardiac-related adverse events (risk ratio [RR]: 1.66 [0.84–3.26], p = 0.14). However, there was increase in incidence of hypertension (RR: 2.30 [1.41–3.73], p = 0.0008) and hypertension crises (RR: 16.87 [2.13–133.34], p = 0.007). A subgroup analysis of the type of ARTA used showed enzalutamide having the highest risk of hypertension (RR: 5.86 [2.10–16.38], p = 0.0008). :Although ARTAs did not show any significant increase in incidence of cardiac-related adverse events, there is an increased risk of hypertension especially with the use of enzalutamide. With this knowledge, closer blood pressure monitoring is needed for patients started on ARTA, especially enzalutamide.