Risk and Timing of Cardiovascular Disease After Androgen-Deprivation Therapy in Men With Prostate Cancer. By O’Farrell et al 2015
Key sentence from the paper: “Men who experienced a CVD event within 1 year before the start of ADT were at the highest risk during the first 6 months of therapy compared with the comparison cohort.”
For the full abstract, see: http://www.ncbi.nlm.nih.gov/pubmed/25732167
Commentary: When it comes to doing good cancer epidemiology the Scandinavian countries and Iceland surpassed the rest of the world because they have a long history of keeping detailed health records on all of their citizens. Researchers can then mine those databases for patterns that would be hard to find without such huge datasets. This is one of these huge, retrospective studies based on many thousands of men treated for prostate cancer.
As previously reported, the authors found an increased risk of cardiovascular disease for patients treated with LHRH drugs compared to men who are not diagnosed with prostate cancer or being treated with just anti-androgen therapy. What stood out in the data was that men, who had two or more cardiovascular events before starting on ADT, showed the greatest risk within six months. The increase was 60% for men on anti-androgen therapy alone, but 91% for those on LHRH drugs. Curiously, those who were treated surgically with an orchiectomy had only a 79% increased risk. So this added to the hint made in the literature some months ago that the risks and benefits of ADT achieved chemically versus surgically may not be quite the same.
The bottom line is that both patients and their physicians need to be well aware of the increased risk of serious cardiac events for patients starting on ADT, who already have a history of cardiovascular disease.
O'Farrell S, Garmo H, Holmberg L, Adolfsson J, Stattin P, Van Hemelrijck M. Risk and Timing of Cardiovascular Disease After Androgen-Deprivation Therapy in Men With Prostate Cancer. J Clin Oncol. 2015.