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GLP-1 Receptor Agonists and Cardiovascular Events During Androgen Receptor Pathway Inhibitor Therapy.

Katelyn M Atkins1,2, Nikhil Chakravarty1, Maria Oorloff1

  • 1Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.

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Summary

Early use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) before androgen receptor pathway inhibitors (ARPIs) may reduce cardiac events in prostate cancer patients. This suggests GLP-1 RAs could mitigate cardiovascular risk during ARPI therapy.

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Area of Science:

  • Cardiology
  • Oncology
  • Pharmacology

Background:

  • Androgen receptor pathway inhibitors (ARPIs) are crucial for high-risk and metastatic prostate cancer but increase cardiovascular risk.
  • Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are known to reduce cardiovascular events in general populations.
  • The cardiovascular impact of GLP-1 RAs in patients undergoing ARPI therapy remains unclear.

Purpose of the Study:

  • To investigate the association between GLP-1 RA use and cardiovascular events in men receiving ARPIs for prostate cancer.
  • To determine if the timing of GLP-1 RA initiation (before or after ARPIs) influences cardiac event risk.

Main Methods:

  • Retrospective analysis of 120 men with prostate cancer treated with ARPIs (2015-2025).
  • Categorized GLP-1 RA use as pre- or post-ARPI initiation.
  • Estimated cumulative incidences of major adverse cardiac events (MACE) and grade ≥2 cardiac events using Fine-Gray regression, accounting for non-cardiac death.

Main Results:

  • Median follow-up was 2.3 years; 45% had pre-existing atherosclerotic cardiovascular disease.
  • GLP-1 RA use prior to ARPI initiation (55% of patients) was associated with a reduced risk of grade ≥2 cardiac events (SHR 0.26, p=0.036) after adjustment.
  • The 2-year cumulative incidence of MACE was 1.7%, and grade ≥2 cardiac events was 16.1%.

Conclusions:

  • Initiating GLP-1 RAs before ARPI therapy may lower the risk of cardiac events in prostate cancer patients.
  • Early metabolic optimization with GLP-1 RAs could be a strategy to mitigate cardiovascular risk during ARPI treatment.
  • Further investigation is warranted to confirm these hypothesis-generating findings.