Comparing the risk of cardiovascular disease following GnRH agonist and GnRH antagonist therapy for patient with prostate cancer: a systematic review and meta-analysis

Minerva Urol Nephrol. 2021 Jun;73(3):276-282. doi: 10.23736/S2724-6051.20.03756-X. Epub 2020 Nov 27.


Introduction: The aim of this review is to compare the risk of cardiovascular disease (CVD) following gonadotropin-releasing hormone (GnRH) agonist and GnRH antagonist therapy for patient with prostate cancer (PCa).

Evidence acquisition: We searched PubMed, Web of science, Opengery, Cochrane library databases and international congress reports for studies published before December 2019. This meta-analysis was conducted using Stata v. 12.0. Relative ratios (RRs) and their credible intervals (CI) were applied for the cardiovascular safety evaluation of androgen-deprivation therapy (ADT) medical interventions, including GnRH agonist and GnRH antagonist therapy. In addition, fixed-effect or random-effect models were applied in the statistical analyses according to the heterogeneity.

Evidence synthesis: Six articles including 32,997 participants were analyzed with a random effects model. The results of meta-analysis showed that compared with GnRH agonist, the incidents of CVD was equal to GnRH antagonist therapy for patient with PCa (RR=0.98, 95% CI: 0.94-1.02). When considering, under sub-group analysis with randomized controlled trials (RCTs) or controlled clinical trials (CCTs), no statistical differences in risk of CVD were found in two sub-group analyses. No evidence of publication bias was found in our meta-analysis by a funnel plot (Pr> | z |=0.26).

Conclusions: This meta-analysis indicates that compared treatment with GnRH antagonist, risks of CVD in PCa patients was the same as GnRH agonist. Further RCTs are strongly required to provide more definitive evidence.

Publication types

  • Comparative Study
  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Antineoplastic Agents, Hormonal / adverse effects*
  • Antineoplastic Agents, Hormonal / therapeutic use
  • Cardiovascular Diseases / chemically induced*
  • Cardiovascular Diseases / epidemiology
  • Gonadotropin-Releasing Hormone / adverse effects*
  • Gonadotropin-Releasing Hormone / agonists
  • Gonadotropin-Releasing Hormone / antagonists & inhibitors
  • Gonadotropin-Releasing Hormone / therapeutic use
  • Humans
  • Male
  • Models, Statistical
  • Prostatic Neoplasms / drug therapy*
  • Risk


  • Antineoplastic Agents, Hormonal
  • Gonadotropin-Releasing Hormone