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ADT increases risk for cardiovascular disease in men with prostate cancer
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Patients with prostate cancer who received androgen-deprivation therapy demonstrated an increased risk for cardiovascular disease, according to study results.
Men with a previous history of cardiovascular events were at a particularly increased risk for cardiovascular disease (CVD) with androgen-deprivation therapy (ADT), results showed.
Sean O’Farrell, BSc, MRes, of the division of cancer studies at King’s College London School of Medicine, and colleagues used the Swedish national health care registries to identify 41,362 patients who received ADT for prostate cancer. The analysis also included a control group of 187,785 age-matched, cancer-free men.
The mean age of men who received ADT was 75.7 years, and the mean age of the comparison cohort was 75.3 years.
Types of ADT utilized in the patients included anti-androgens (n = 10,656), gonadotropin-releasing hormone (GnRH) agonists (n = 7,789), GnRH agonists with flare protection (n = 18,166), combined androgen blockade (CAB) therapy (n = 1,004) and surgical orchiectomy (n = 3,747).
Men who received GnRH agonists (HR = 1.21; 95% CI, 1.18-1.25) and men who underwent orchiectomy (HR = 1.16; 95% CI, 1.04-1.21) demonstrated increased risks for CVD compared with the control population. However, men who received anti-androgens demonstrated a reduced risk for CVD (HR = 0.87; 95% CI, 0.82-0.91).
Men who had experienced two or more cardiovascular events prior to therapy were at greatest risk for CVD within the first 6 months of ADT with GnRH agonist therapy (HR = 1.91; 95% CI, 1.66-2.2), anti-androgens (HR = 1.6; 95% CI, 1.35-2.06) or orchiectomy (HR = 1.79; 95% CI, 1.16-2.76) compared with the control population.
These results confirm previous findings that suggested CVD incidence increases in men with a history of the disease prior to treatment, researchers wrote.
“By use of data on age- and county-matched prostate cancer-free men and detailed information on ADT duration, the current study confirms these findings but also adds information to the temporal association between ADT and CVD risk,” the researchers wrote.
The study’s findings should lead to a better overall understanding of the benefits and risks of ADT-based treatments for prostate cancer, researchers also said.
“Our study suggests an increased risk of CVD within the first year from starting GnRH agonist therapy or orchiectomy, especially in men with history of a CVD event within 1 year before ADT,” O’Farrell and colleagues concluded. “There should be solid indication of use of ADT so that the perceived benefit outweighs possible harm. This is particularly important in men with a recent history of CVD.” – by Cameron Kelsall
Disclosure: O’Farrell reports no relevant financial disclosures. Other researchers report consulting/advisory roles with and travel expenses from Ferring.
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