促性腺激素释放激素 (GnRH) 拮抗剂和激动剂是前列腺癌的基础治疗方法。然而，临床试验中有关这些药物心血管安全性比较的证据尚无定论。本研究的目的是通过现实世界的证据研究系统地评估 GnRH 拮抗剂与 GnRH 激动剂相比的不良心血管事件风险。我们对 PubMed、Embase、Cochrane Library、Scopus 和 Web of Science (2008) 进行了系统检索-2023）。我们纳入了现实世界的证据研究，比较了前列腺癌患者中 GnRH 拮抗剂与 GnRH 激动剂的心血管结局风险。我们对低或中等偏倚风险的研究的效果估计进行了荟萃分析，通过非随机干预研究中的偏倚风险 (ROBINS-I) 工具，使用随机效应模型进行评估。在十项纳入的研究中，四名被归类为具有中等偏倚风险，六名被归类为具有严重偏倚风险。在初步分析中存在中等偏倚风险的三项研究中，地加瑞克与主要不良心血管事件 (MACE) 风险增加相关（汇总相对风险 [RR]：1.31，95% 置信区间 [CI]：1.14-1.51） ）。与一项针对无心血管疾病史患者的研究（RR：1.15，95% CI：1.11-1.56）相比，两项针对有心血管疾病史患者的研究（汇总 RR：1.31，95％ CI：1.11-1.56）观察到风险增加：0.83-1.59）。现实世界证据研究表明，与 GnRH 激动剂相比，地加瑞克与 MACE 风险适度增加相关，特别是在有心血管疾病史的患者中。然而，由于高危患者接受地加瑞克治疗而产生的残留混杂因素可能是这些发现的原因。需要更多关于肿瘤特征和心血管危险因素的详细数据的大型研究来证实这些发现。在对常规护理中诊断出的前列腺癌患者的证据进行的系统评估中，地加瑞克与促性腺激素释放激素激动剂相比，与更高的心血管不良后果相关.版权所有 © 2024 作者。由 Elsevier B.V. 出版。保留所有权利。

Gonadotropin-releasing hormone (GnRH) antagonists and agonists are cornerstone treatments in prostate cancer. However, evidence regarding the comparative cardiovascular safety of these drugs from clinical trials is inconclusive. The objective of this study was to systematically assess the risk of adverse cardiovascular events of GnRH antagonists compared with GnRH agonists across real-world evidence studies.We conducted a systematic search of PubMed, Embase, Cochrane Library, Scopus, and Web of Science (2008-2023). We included real-world evidence studies comparing the risk of cardiovascular outcomes of GnRH antagonists with those of GnRH agonists among patients with prostate cancer. We conducted a meta-analysis of effect estimates across studies at a low or moderate risk of bias, assessed via the Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) tool, using random-effect models.Among ten included studies, four were classified as having a moderate and six as having a serious risk of bias. Across three studies at a moderate risk of bias in the primary analysis, degarelix was associated with an increased risk (pooled relative risk [RR]: 1.31, 95% confidence interval [CI]: 1.14-1.51) of major adverse cardiovascular events (MACEs). An augmented risk was observed in two studies among patients with a history of cardiovascular disease (pooled RR: 1.31, 95% CI: 1.11-1.56) compared with one study among patients without a history of cardiovascular disease (RR: 1.15, 95% CI: 0.83-1.59).Real-world evidence studies indicate that degarelix, compared with GnRH agonists, is associated with a modest increased risk of MACEs, particularly among patients with a history of cardiovascular disease. However, residual confounding due to the treatment of high-risk patients with degarelix may account for these findings. Additional large studies with detailed data on tumor characteristics and cardiovascular risk factors are needed to confirm these findings.In this systematic evaluation of evidence among patients diagnosed with prostate cancer in routine care, degarelix was associated with higher cardiovascular adverse outcomes than gonadotropin-releasing hormone agonists.Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.