We have here two massive reviews of the literature associating ADT with the risk of stroke and cardiovascular disease. Both papers are out of Tianjin Medical University in Tianjin, China. Both are meta-analyses; i.e., studies that statistically compile the results of smaller individual studies.
The paper on stroke (Liu et al., 2019) reviewed ten studies that collectively included data from almost 240,000 patients. The one on cardiovascular disease (Liang et al., 2019) was built upon data from eight studies that included information from over 316,000 patients. That is an impressive amount of data.
ADT was associated with a slight, but significant risk of stroke. The risk was equivalent for all modes of androgen suppression, including LHRH drugs (like Lupron and Zoladex), surgical castration, and anti-androgen drugs (like Casodex) as monotherapy. One novel and unanticipated finding was that the inclusion of an oral anti-androgen, like Casodex, along with an LHRH drug might slightly lower the risk of stroke associated with the LHRH drugs. The authors quite rightly suggest that such a finding warrants further exploration.
As for cardiovascular risk, a suite of cardiovascular diseases was assessed. Although there were some differences between the specific disease and the level of risk, the big one that stood out was a heightened risk of an acute myocardial infarction (AMI). That is what is commonly called a heart attack.
All forms of ADT were associated with an elevated risk of an AMI. There were some small differences in risk of cardiovascular disease between the different modalities of ADT treatment. However, the patient populations in each treatment group were not identical (e.g., older men were more likely to have an orchiectomy), so results should be interpreted cautiously.
All of this points to the need for patients on ADT to adhere to a heart-healthy lifestyle with adequate exercise and a heart-healthy diet.
An abstract from the meta-analysis on ADT and stroke can be found at: https://www.ncbi.nlm.nih.gov/pubmed/31747673
Liu, R., Zhou, J., Xia, S., & Li, T. (2019). Androgen Deprivation Therapy and the Risk of Stroke in Patients with Prostate Cancer: An Updated Systematic Review and Meta-Analysis. Urologia Internationalis. Advance Online Publication. doi: 10.1159/000503906
An abstract from the meta-analysis on ADT and cardiovascular disease can be found at: https://www.ncbi.nlm.nih.gov/pubmed/31743594
Liang, Z., Zhu, J., Chen, L., Xu, Y., Yang, Y., Hu, R., Zhang, W., Song, Y., Lu, Y., Ou, N., & Liu, X. (2019). Is Androgen Deprivation Therapy for Prostate Cancer Associated with Cardiovascular disease? A Meta-Analysis and systematic review. Andrology. Advance Online Publication. doi: 10.1111/andr.12731