Increased risk of cardiovascular disease during hormone therapy

This study examined the risk of cardiovascular disease (CVD) in men undergoing treatment with androgen deprivation therapy (ADT) for prostate cancer. Researchers reported an increased CVD risk in men undergoing ADT within the first year of treatment. CVD risk was dependent on the type of ADT and the patient’s history.

Androgen deprivation therapy (ADT) is a type of hormone therapy commonly used to treat prostate cancer. ADT targets the production of androgens (male sex hormones such as testosterone) and reduces their effect on cancer cell growth. ADT can involve the surgical removal of the testicles (also called orchiectomy) or drug treatment. Drug treatments either lower the production of testosterone in the body (GnRH agonists) or block the action of androgens (antiandrogens).

Previous studies have suggested that there is an increased risk of cardiovascular disease (CVD; heart and blood vessel disease) among patients receiving ADT. However, evidence to this effect is mixed, with some studies reporting no effect of ADT on CVD risk.

The aim of this study was to examine the risk of CVD in men undergoing ADT.

The records of 41,362 men undergoing ADT for prostate cancer were included in this analysis. 3,747 men underwent orchiectomy. 26,959 received treatment with GnRH agonists. 10,656 men received antiandrogens. The incidence of CVD was compared to that of healthy men without prostate cancer over a period of up to 5 years.

Men undergoing treatment with GnRH agonists were 21% more likely to have a CVD event compared to the healthy control group. The risk of CVD for men that underwent orchiectomy increased by 16% compared to healthy men. This remained significant regardless of previous history of CVD or not. However, men undergoing treatment with antiandrogens were 13% less likely to experience a CVD event.

CVD risk was higher in early phases of treatment after ADT compared to later phases of treatment. Overall, CVD risk was highest during the first 6 months of ADT. The risk of CVD within the first 6 months of ADT was especially increased (by 60 to 91% depending on type of ADT) in men with two or more previous incidences of CVD, especially if the latest incidence occurred within a year before starting ADT. The risk of CVD in these men then steadily decreased with GnRH agonist or antiandrogen treatment, but remained high for up to 12 months in the orchiectomy group.

Researchers concluded that ADT is associated with an increased CVD risk within the first year of treatment. CVD risk was highest in men with a history of CVD within 1 year before ADT.

Discuss with your doctor any possible risk factors for cardiovascular disease.