It is well known that for men with prostate cancer who are treated long term with LHRH agonist drugs, like Lupron and Zoladex, there is an increased risk of metabolic syndrome. That, in turn, increases their risk of both diabetes and heart disease. But is the cardiovascular risk further elevated in men on ADT who already have diabetes when they begin on ADT?
In this large database study from Sweden, the researchers followed approximately 700 men with prostate cancer and diabetes for five years while on the LHRH agonist drugs.
The simple answer to the question in the title of this blog is “yes.“ Indeed, there is an increased risk of cardiovascular disease in men with diabetes, who start ADT for prostate cancer using the standard LHRH agonist drugs. This risk is higher relative to the estimated risk among men who don’t have pre-existing diabetes when starting ADT. In other words, having diabetes increases the risk of heart disease in men on ADT above and beyond the risk associated with ADT itself.
One interesting secondary finding from the paper is that men on ADT did not show signs of elevated blood pressure. It had been shown previously in animal studies that androgen suppression is more likely to lower than raise blood pressure. The authors feel that more research in that area is warranted, and we agree.
Meanwhile, if one is likely to be a candidate for ADT and one is already diabetic or at increased risk of diabetes, this study suggests that they should do what they can to control their diabetic risk BEFORE starting on ADT.
To read the study abstract, see: https://pubmed.ncbi.nlm.nih.gov/35939302/
Reference:
Association of Gonadotropin-Releasing Hormone Agonists for Prostate Cancer With Cardiovascular Disease Risk and Hypertension in Men With Diabetes.Lin E, Garmo H, Van Hemelrijck M, Zethelius B, Stattin P, Hagström E, Adolfsson J, Crawley D.JAMA Netw Open. 2022 Aug 1;5(8):e2225600. doi: 10.1001/jamanetworkopen.2022.25600.PMID: 35939302