Prediction of cardiovascular complications in patients with prostatic cancer treated with estrogen

The authors made a randomized prospective study of estrogen therapy versus orchidectomy in patients with prostatic cancer (n = 100, Huddinge Hospital, Sweden) to investigate the possibility of predicting cardiovascular events during hormonal treatment. Patients with preexisting cardiovascular morbidity were excluded (16%). Prior to the allocation of therapy, the following were performed: exercise stress test; physiologic evaluation of the peripheral circulation; blood volume estimation; chest x-ray; blood tests, including hormones, lipoproteins, and antithrombin III; and a physical examination and history by a cardiologist. Thirteen (25%) of the patients given estrogen therapy (n = 53) had cardiovascular complications during the first year of treatment compared with none in the orchidectomy group. The authors made a multivariate discriminant analysis of the pretreatment examinations of the estrogen-treated patients; this resulted in a discriminant function including S-T segment depression in lead CH2 during the exercise stress test and blood tests for cholesterol, follicle-stimulating hormone, and luteinizing hormone. This function correctly classified 84% of the estrogen-treated patients as patients with or without risk of a cardiovascular complication. Briefly stated, if patients with prostatic cancer are examined by means of exercise stress tests and blood tests for luteinizing hormone, cholesterol, and follicle-stimulating hormone prior to treatment, the discriminant function enables the authors to identify an extremely high-risk group for cardiovascular complications if estrogen therapy is commenced. The strong association of an increased luteinizing hormone with cardiovascular complications during estrogen treatment makes it mandatory to investigate its role in the pathogenesis of atherosclerosis and cardiovascular events.