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Published on: March 6, 2018
Androgen deprivation therapy increases cardiovascular morbidity in men with prostate cancer
Christopher S Saigal1, John L Gore, Tracey L Krupski
1Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California 90095, USA. csaigal@mednet.ucla.edu
Insights
Androgen deprivation therapy (ADT) increases cardiovascular risk in prostate cancer patients by 20% within a year. This highlights the need for cardiac risk management, especially in low-risk cases.
Area of Science:
- Oncology
- Cardiology
- Public Health
Background:
- Prostate cancer treatment increasingly uses androgen deprivation therapy (ADT).
- Cardiovascular disease is a leading cause of death in prostate cancer patients.
- Limited data exist on ADT's cardiovascular impact in this population.
Purpose of the Study:
- To assess the risk of cardiovascular morbidity in prostate cancer patients undergoing ADT.
- To quantify the association between ADT and cardiovascular events.
Main Methods:
- Retrospective cohort study of 22,816 newly diagnosed prostate cancer patients (1992-1996).
- Utilized Medicare claims data to define ADT exposure and cardiovascular morbidity.
- Multivariate models were employed to calculate risk.
Main Results:
- ADT use for ≥1 year was linked to a 20% increased risk of serious cardiovascular morbidity.
- This elevated risk was observed within 12 months of initiating ADT.
- Hispanic men showed a reduced risk of cardiovascular morbidity.
Conclusions:
- ADT is associated with significantly increased cardiovascular morbidity in prostate cancer patients.
- Consideration of ADT use is crucial, particularly when benefits are not clearly established.
- Mitigation strategies like lifestyle changes and medication may reduce ADT-related cardiac risks.
Background:
The use of androgen deprivation therapy (ADT) in the treatment of men with prostate cancer has risen sharply. Although cardiovascular disease is the most common reason for death among men with prostate cancer who do not die of the disease itself, data regarding the effect of ADT on cardiovascular morbidity and mortality in men with prostate cancer are limited. In the current study, the authors attempted to measure the risk for subsequent cardiovascular morbidity in men with prostate cancer who received ADT.
Methods:
A cohort of newly diagnosed men in a population-based registry who were diagnosed between 1992 and 1996 were identified retrospectively. A total of 22,816 subjects were identified after exclusion criteria were applied. Using a multivariate model, the authors calculated the risk of subsequent cardiovascular morbidity in men with prostate cancer who were treated with ADT, as defined using Medicare claims.
Results:
Newly diagnosed prostate cancer patients who received ADT for at least 1 year were found to have a 20% higher risk of serious cardiovascular morbidity compared with similar men who did not receive ADT. Subjects began incurring this higher risk within 12 months of treatment. However, Hispanic men were found to have a lowered risk for cardiovascular morbidity.
Conclusions:
ADT is associated with significantly increased cardiovascular morbidity in men with prostate cancer and may lower overall survival in men with low-risk disease. These data have particular relevance to decisions regarding the use of ADT in men with prostate cancer in settings in which the benefit has not been clearly established. For men with metastatic disease, focused efforts to reduce cardiac risk factors through diet, exercise, or the use of lipid-lowering agents may mitigate some of the risks of ADT.
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