It is well established that ADT carries an increased risk of cardiovascular disease (CVD). However, there may be nuances in terms of the likelihood of intervention for CVD, such as coronary angioplasty or coronary bypass surgery, for men on ADT with a previous history of CVD.
Indeed, a new study conducted by researchers in South Korea found that men who had a previous history of CVD, cerebrovascular disease (i.e., strokes), or interventions to treat CVD were not at an increased risk of getting those procedures after starting ADT. The researchers analyzed data from a large, nationwide health database, involving information from nearly 50,000 prostate cancer patients (mean age 73 years). A technique called one-to-one matching was used to compare the relative risk of CVD interventions in men with prostate cancer, who were on ADT versus those not on ADT (approximately 10,000 men per group).
A unique aspect of the study was the specific focus on men with a previous history of CVD. In these patients, ADT was not significantly associated with an increase in the risk of further cardiovascular interventions, regardless of ADT duration or addition of anti-androgens.
The researchers hypothesized that men with a prior history of CVD, strokes, or interventions to treat CVD may have implemented beneficial lifestyles—e.g., increased exercise, quitting smoking, weight loss—to buffer their risk of further invasive treatments for CVD.
That is a fascinating hypothesis which is worth further exploration. If it’s a correct hypothesis for men in South Korea, does it hold for other ethnic groups and for patients in parts of world where access to health care is limited, where more men smoke, exercise less, and are overweight?
To conclude, the authors note: “Undoubtedly, an unnecessary use of ADT should be avoided, and if ADT is prescribed, potential side effects should be closely monitored. However, excessive warnings of cardiovascular risk could hinder the choice of an appropriate treatment.” As always, it’s best to talk about any risks and benefits of ADT with one’s medical team.
To read the study abstract, see: https://pubmed.ncbi.nlm.nih.gov/34315660/
Kim, D. K., Lee, H. S., Park, J. Y., Kim, J. W., Hah, Y. S., Ha, J. S., Kim, J. H., & Cho, K. S. (2021). Risk of cardiovascular intervention after androgen deprivation therapy in prostate cancer patients with a prior history of ischemic cardiovascular and cerebrovascular disease: A nationwide population-based cohort study. Urologic Oncology, S1078-1439(21)00302-1. Advance online publication. https://doi.org/10.1016/j.urolonc.2021.07.002