There are rising concerns regarding the cardiovascular diseases associated with androgen deprivation therapy (ADT) for prostate cancer (PCa). This study aims to investigate the relationship between the dynamic changes (from baseline to 3 months after ADT) of serum albumin-to-globulin ratio (AGR) and major adverse cardiovascular events (MACE) in PCa patients undergoing ADT. Male patients aged >60 years diagnosed with PCa undergoing ADT in Hong Kong (China) between December 01, 1999, and March 31, 2021, were included. AGR values at baseline and after 3 months of ADT initiation were recorded. The incidence of new-onset 4-point MACE (4P-MACE) and composite of adverse cardiovascular events (CACE) were designated as the primary outcomes. The individual components of CACE were designated as the secondary outcomes. A total of 970 patients were analyzed, with age (mean ± standard deviation) of 75.1 ± 7.8 years. The number of patients with increased AGR and decreased AGR were 515 (53.1%) and 455 (46.9%), respectively. Patients with a decreased AGR had significantly higher risks of 4P-MACE, CACE, heart failure (HF), myocardial infarction (MI), and stroke than patients with an increased AGR. No significant difference in the risk of all-cause mortality between the two groups was observed (hazard ratio: 1.049, 95% confidence interval: 0.879–1.253, P = 0.594). Moreover, the change in AGR outperformed the baseline AGR in predicting 4P-MACE, CACE, HF, MI, and stroke. In PCa patients undergoing ADT, dynamic changes of AGR are associated with risks for 4P-MACE, CACE, HF, MI, and stroke.

Keywords: albumin-to-globulin ratio; androgen deprivation therapy; cardiovascular risk; prostate cancer