Regular use of aspirin is associated with a lower cardiovascular risk in prostate cancer patients receiving gonadotropin-releasing hormone therapy

Wei-Ting Chang; Chon-Seng Hong; Kun-Lin Hsieh; Yi-Chen Chen; Chung Han Ho; Jhih-Yuan Shih; Wei-Chih Kan; Zhih-Cherng Chen; You-Cheng Lin

doi:10.3389/fonc.2022.952370

Regular use of aspirin is associated with a lower cardiovascular risk in prostate cancer patients receiving gonadotropin-releasing hormone therapy

Front Oncol. 2022 Sep 12:12:952370. doi: 10.3389/fonc.2022.952370. eCollection 2022.

Authors

Wei-Ting Chang^{1

2

3}, Chon-Seng Hong^{1

4}, Kun-Lin Hsieh^{5

6}, Yi-Chen Chen⁷, Chung Han Ho^{7

8}, Jhih-Yuan Shih^{1

4}, Wei-Chih Kan^{9

10}, Zhih-Cherng Chen¹, You-Cheng Lin¹¹

Affiliations

¹ Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan.
² Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan.
³ Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
⁴ Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
⁵ Division of Urology, Department of Surgery, Chi-Mei Medical Center, Tainan, Taiwan.
⁶ Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
⁷ Department of Medical Research , Chi-Mei Medical Center, Tainan, Taiwan.
⁸ Department of Health and Nutrition , Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
⁹ Division of Nephrology, Department of Internal medicine, Chi Mei Medical Center, Tainan, Taiwan.
¹⁰ Department of Biological Science and Technology, Chung Hwa University of Medical Technology, Tainan, Taiwan.
¹¹ Division of Plastic Surgery, Department of Surgery, Chi-Mei Medical Center, Tainan, Taiwan.

Abstract

Gonadotropin-releasing hormone (GnRH) therapy has been known to increase risks of major adverse cardiovascular and cerebrovascular events (MACCEs). Herein, we aim to estimate whether regular use of aspirin attenuates risks of MACCEs in prostate cancer patients receiving GnRHs. Using Taiwanese National Health Insurance Research Database (NHIRD), we identified 7719 patients diagnosed with prostate cancer who were either aspirin-naïve, received irregular or regular aspirin from 2008 to 2015. Through a multivariable logistic regression model, we investigated the impact of aspirin on MACCEs. Compared with nonusers and irregular users, most patients receiving regular aspirin were older and had more comorbidities. The crude incidence of one-year MACCEs was lowest in aspirin nonusers but highest in irregular users of aspirin compared with regular users of aspirin (2.65% vs. 4.41% vs. 2.85%, p=0.0099). After adjusting for age, cancer stage and comorbidities, irregular aspirin users had a higher risk of one-year MACCEs (adjusted OR: 1.33; 95% CI: 0.93-1.90, p=0.1139) than aspirin nonusers, but conversely, there was a trend of reducing the risk of MACCEs among those who received regular aspirin (adjusted OR: 0.79; 95% CI: 0.44-1.42, p=0.4256). In the subgroup analysis, there were age- and cancer stage-independent higher risks of MACCEs in patients who took aspirin irregularly compared to those in patients who did not take aspirin. The risks were attenuated in patients receiving regular aspirin. Collectively, regular use of aspirin presented a trend of reducing risks of MACCEs in prostate cancer patients receiving GnRHs. However, irregular use of aspirin diminished the benefits.

Keywords: GnRH therapy; MACCEs; aspirin; cardiotoxicity; prostate cancer.