Related Experiment Video
Updated: Sep 14, 2025
A Bioluminescent and Fluorescent Orthotopic Syngeneic Murine Model of Androgen-dependent and Castration-resistant Prostate Cancer
Published on: March 6, 2018
Adverse Cardiovascular Outcomes of Individuals Treated With Androgen Deprivation Therapy
Eric V Li1,2, Austin Y Ho1, Richard Bennett3
1Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
Insights
Patients with a history of heart attack or stroke face higher risks for major adverse cardiovascular events (MACE) when starting androgen deprivation therapy (ADT). Optimized cardiovascular care is crucial for these patients.
Area of Science:
- Cardiology
- Oncology
- Pharmacology
Background:
- Cardiovascular management for patients on androgen deprivation therapy (ADT) is evolving.
- New medications and practice patterns are emerging in ADT care.
- Identifying factors for major adverse cardiovascular events (MACE) during ADT is critical.
Purpose of the Study:
- To identify factors associated with treatment-onset MACE in patients undergoing ADT.
- To analyze MACE incidence across different ADT eras and medications.
Main Methods:
- Retrospective cohort study of patients receiving pharmacologic ADT (January 2018-March 2024).
- Stratification of patients using leuprolide or degarelix into pre- and post-relugolix eras.
- MACE defined as myocardial infarction, stroke, or cardiovascular-associated death.
Main Results:
- Higher Charlson Comorbidity Index and prior MACE significantly increased MACE risk.
- MACE incidence decreased in the post-relugolix era across leuprolide and degarelix groups.
- Patients with prior MACE were more likely to receive cardiology management, but some lacked adequate care.
Conclusions:
- A history of heart attack or stroke is a significant risk factor for MACE post-ADT initiation.
- Relugolix was not associated with a reduced MACE risk in this analysis.
- There is a need for improved strategies in cardiovascular management for ADT patients.
Introduction:
Cardiovascular management of patients who receive androgen deprivation therapy (ADT) is evolving as new medications and practice patterns emerge. We sought to identify factors associated with treatment-onset major adverse cardiovascular events (MACE) among patients undergoing ADT.
Methods:
This was a retrospective cohort of patients at a multicenter academic institution prescribed pharmacologic ADT from January 2018 to March 2024. Patients using leuprolide or degarelix were stratified into pre-relugolix (January 2018-November 2020) and post-relugolix (December 2020-March 2024) eras. MACE was defined as myocardial infarction, stroke, or cardiovascular-associated death.
Results:
One thousand one hundred twenty-eight and 1398 patients were prescribed leuprolide in the pre-relugolix and post-relugolix era, respectively. Eighty patients were prescribed degarelix, and 367 patients were prescribed relugolix. The incidence of treatment-onset MACE in the pre-relugolix era was 5.4% and 8.3% for leuprolide and degarelix, respectively. Incidence in the post-relugolix era was 2.3%, 3.6%, and 2.1% for leuprolide, degarelix, and relugolix, respectively. Higher Charlson Comorbidity Index (HR 1.12, CI 1.06-1.18, P < .001) and prior MACE (HR 5.32, CI 3.36-8.42, P < .001) were associated with increased risk of treatment-onset MACE. While patients with a history of previous MACE were more likely to be managed by cardiology while receiving ADT (55% vs 23%, P < .001), 27% lacked care from cardiology or primary care during therapy and received cardioprotective therapies.
Conclusions:
A history of heart attack or stroke is significantly associated with increased risk of MACE after initiating ADT. Relugolix was not associated with lower risk of MACE in our analysis. Strategies to optimize the cardiovascular management of patients receiving ADT are needed.
Related Concept Videos
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
01:20Disorders of the Male Reproductive System
Prostate disorders are another major concern. These conditions can impair urinary flow due to the prostate's location around the urethra....
01:27Adrenal Gland Disorders
Adrenal insufficiency, characterized by insufficient cortisol and aldosterone production, leads to conditions like Addison's disease. This disorder, affecting the adrenal cortex, exhibits symptoms such as skin bronzing, dehydration, low blood pressure, fatigue, and weight loss. Congenital adrenal hyperplasia, a genetic ailment causing...
01:18Treatment for Pulmonary Arterial Hypertension: Endothelin Receptor Antagonists
ETs are synthesized through a complex sequence of enzymatic steps, primarily involving an enzyme referred to as endothelin-converting enzyme...
01:20Exercise and Cardiovascular Response
Light to moderate physical activity initiates a series of interconnected responses in the body. The heart rate modestly increases in anticipation of the workout, followed by widespread vasodilation as oxygen consumption by skeletal muscles increases. This results in decreased peripheral resistance, increased capillary blood flow, and accelerated...
01:22Adrenergic Antagonists: Pharmacological Actions of ɑ-Receptor Blockers
α1-blockers: These drugs inhibit α1-adrenoceptors on smooth muscle cells, resulting in vasodilation. This vasodilation lowers blood pressure, making α1-blockers valuable in treating hypertension. Additionally,...