雄激素受体途径抑制剂 (ARPIs) 极大地改变了晚期/转移性前列腺癌 (PCa) 的治疗。然而，它们的心血管毒性仍有待阐明。为了分析和比较不同 ARPI 的 PCa 患者治疗后继发心血管事件的风险。2023 年 8 月，我们查询了 PubMed、Scopus 和 Web of Science 数据库以确定随机对照研究（随机对照试验 (RCT)，分析接受阿比特龙、阿帕鲁胺、达洛鲁胺和恩杂鲁胺治疗的 PCa 患者。感兴趣的主要结局是心脏疾病、心力衰竭、缺血性心脏病（IHD）、心房颤动（AF）和高血压的发生率。进行网络荟萃分析 (NMA)，以比较每种 ARPI 加雄激素剥夺疗法 (ADT) 与标准护理 (SOC) 的不同结果。总体而言，纳入了 26 项随机对照试验。 ARPI 与心脏疾病（RR：1.74，95% CI：1.13-2.68，p = 0.01）、心力衰竭（RR：2.49，95% CI：1.05-5.91，p = 0.04）、房颤（AF）风险增加相关。 RR：2.15，95% CI：1.14-4.07，p = 0.02），高血压（RR：2.06，95% CI：1.67-2.54，p < 0.01）≥3级。根据 NMA，阿比特龙会增加 ≥3 级心脏病（RR：2.40，95% CI：1.42-4.06）和高血压（RR：2.19，95% CI：1.77-2.70）的风险。恩杂鲁胺与 ≥3 级 AF（RR：3.17，95% CI：1.05-9.58）和高血压（RR：2.30，95% CI：1.82-2.92）的增加相关。ADT 中添加 ARPI 会增加以下风险：心脏疾病，包括 IHD 和 AF，以及高血压。每个 ARPI 都表现出独特的心血管事件特征。对于接受 ARPI  ADT 治疗的患者来说，仔细选择患者并警惕心血管问题监测至关重要。© 2024。作者。

Androgen-receptor pathway inhibitors (ARPIs) have dramatically changed the management of advanced/metastatic prostate cancer (PCa). However, their cardiovascular toxicity remains to be clarified.To analyze and compare the risks of cardiovascular events secondary to treatment of PCa patients with different ARPIs.In August 2023, we queried PubMed, Scopus, and Web of Science databases to identify randomized controlled studies (RCTs) that analyze PCa patients treated with abiraterone, apalutamide, darolutamide, and enzalutamide. The primary outcomes of interest were the incidence of cardiac disorder, heart failure, ischemic heart disease (IHD), atrial fibrillation (AF), and hypertension. Network meta-analyses (NMAs) were conducted to compare the differential outcomes of each ARPI plus androgen deprivation therapy (ADT) compared to standard of care (SOC).Overall, 26 RCTs were included. ARPIs were associated with an increased risk of cardiac disorders (RR: 1.74, 95% CI: 1.13-2.68, p = 0.01), heart failure (RR: 2.49, 95% CI: 1.05-5.91, p = 0.04), AF (RR: 2.15, 95% CI: 1.14-4.07, p = 0.02), and hypertension (RR: 2.06, 95% CI: 1.67-2.54, p < 0.01) at grade ≥3. Based on NMAs, abiraterone increased the risk of grade ≥3 cardiac disorder (RR:2.40, 95% CI: 1.42-4.06) and hypertension (RR:2.19, 95% CI: 1.77-2.70). Enzalutamide was associated with the increase of grade ≥3 AF(RR: 3.17, 95% CI: 1.05-9.58) and hypertension (RR:2.30, 95% CI: 1.82-2.92).The addition of ARPIs to ADT increases the risk of cardiac disorders, including IHD and AF, as well as hypertension. Each ARPI exhibits a distinct cardiovascular event profile. Selecting patients carefully and vigilant monitoring for cardiovascular issues is imperative for those undergoing ARPI + ADT treatment.© 2024. The Author(s).