Reviewing the cardicovascular effects of androgen deprivation therapy in prostate cancer

The authors aimed to determine whether patients who received androgen deprivation therapy were more at risk of experiencing cardiovascular events.

Androgen deprivation therapy (ADT) is a hormone treatment that targets male sex hormones involved in prostate cancer development, such as testosterone, in early stage prostate cancer patients.

Cardiovascular disease (heart disease) has previously been linked to ADT, typically in the form of acute myocardial infarction (heart attack) or strokes.

The aim of this meta-analysis (combination of data from numerous reports) was to determine whether ADT increased the risk of cardiovascular events in prostate cancer.

137,658 patients were used in this study who received ADT for more than 6 months.

122,969 patients in total were evaluated for heart attack. In clinical trials, patients (8,211) did not experience any differences in the occurrence of heart attack when treated with ADT. However, in real-life studies (i.e. studies that are not as well controlled as clinical trials but reflect actual, long term treatment outcomes in the population) patients (114,758) showed a higher incidence of heart attack when treated with ADT where patients were over two times more likely to experience a heart attack compared to those who did not receive ADT.

116, 074 patients were analysed for non-fatal cardiovascular events (such as non-fatal heart attack, non-fatal strokes or blood clotting). Patients in clinical trials (1,316) showed a significantly higher occurrence of non-fatal cardiovascular events following ADT, with the odds of experiencing an event 1.55 times more likely than those who did not receive ADT. A total of 83 non-fatal events occurred in 654 patients who received ADT for at least 6 months compared to 55 events in 662 patients who did not receive ADT.

There was no association between non-fatal cardiovascular events and ADT found in real-life studies. When both types of study were combined there was no increase in the incidence of non-fatal events.

There were no differences found in either type of study to indicate that ADT treatment increased the risk of experiencing a stroke or cardiovascular mortality (death from cardiovascular disease or cardiovascular event).

The authors concluded that despite differences in results between carefully controlled clinical trials and real-life studies, frequent cardiovascular evaluations should be carried out in men undergoing ADT for localized prostate cancer. 

There were differences between the patient groups used in this analysis which may have biased the results.

If you are considering androgen deprivation therapy and have concerns about the risks associated with the treatment, please consult your doctor.