Does androgen-deprivation therapy increase risk of mortality from heart attack or stroke?

This study examined the risk of heart-related mortality in patients undergoing androgen-deprivation therapy (ADT) for prostate cancer. It found that patients treated with radiation therapy and ADT did not have an increased risk of heart-related mortality.

Prostate cancer is often treated with radiation therapy to shrink the tumor. This can be assisted by a therapy called androgen-deprivation therapy (ADT). Androgens such as testosterone are male sex hormones that help prostate cancer to grow. Therefore, hormonal therapy such as ADT that blocks the effects of androgens or reduces their levels lowers the ability of the tumor to grow.  

The reduction of androgens causes many metabolic changes. It is thought that ADT may increase risk of heart disease. However, what effect ADT has on heart disease is not clear based on preexisting heart problems. In particular, it is unclear if ADT increases the risk of heart-related death in high-risk patients. 

1,463 patients with prostate cancer were involved in this study. 565 patients received radiation therapy (RT) alone, while 898 patients received RT and ADT. Patients were evaluated for heart disease risk factors such as smoking, diabetes, high blood pressure, obesity, or a history of heart attack or stroke. Patients were followed for an average of 66 months. 

60.2% of patients had heart disease risk factors. The use of ADT and RT compared to RT alone was not associated with an increased risk of heart-related death due to heart attack or stroke. Even in patients with heart disease risk factors, there was still no increase in heart-related death with ADT.

This study showed that ADT in combination with RT does not increase the risk of heart-related death in patients with prostate cancer regardless of the existence of cardiovascular risk factors. 

It is possible that the study follow-up period of 5.5 years was too short to identify all heart-related deaths. Further research would be helpful to confirm these findings.