Androgen deprivation therapy (ADT) may increase the risk of cardiovascular disease (CVD), such as heart failure, arrhythmias, and conduction disorders in men with localized prostate cancer who undergo active surveillance, according to a study published in the British Journal of Cancer.
ADT, previously recommended for advanced prostate cancer, is becoming more commonly recommended for patients with localized prostate cancer. Reports of adverse effects are increasing as ADT use becomes more prevalent, not only for conditions caused by testosterone deprivation such as erectile dysfunction and gynecomastia, but for CVD as well.
For this prospective study, researchers identified 7637 patients with local prostate cancer who did not undergo curative intent therapy upon diagnosis. At the median follow-up of 3.4 years, nearly 30% of study patients were exposed to ADT. Patients were enrolled regardless of their CVD history.
ADT exposure was associated with a 27% increase in risk of heart failure compared to nonexposed men (adjusted hazard ratio [AHR], 1.27; 95% CI, 1.06-1.51). This increase was observed in men without preexisting CVD (AHR, 1.81; 95% CI, 1.40-2.32), but not in men with preexisting CVD (AHR, 1.00, 95% CI, 0.78-1.29).
For men with preexisting CVD, an increase in the risk for arrhythmia (AHR, 1.44; 95% CI, 1.02-2.01) and conduction disorder (AHR, 3.11; 95% CI, 1.22-7.91) were observed.
The authors of the study conclude by saying “this study provides the basis for identifying susceptible individuals for regular cardiac check-up, including identifying subclinical signs, monitoring hypertension, diabetes, and encouraging physical activity and healthy dietary habits.”
1. Haque R, Yood MU, Xu X, et al. Cardiovascular disease risk and androgen deprivation therapy in patients with localized prostate cancer: a prospective cohort study [published online August 24, 2017]. Br J Cancer. doi: 10.1038/bjc.2017.280