Cardiovascular Complications of Prostate Cancer Treatment

Wilk, Michał; Waśko-Grabowska, Anna; Szmit, Sebastian

doi:10.3389/fphar.2020.555475

Cited by 21 publications

(22 citation statements)

References 86 publications

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“…The rationale regarding the association between ADT and end organ adverse events came from consequences stemming from androgen receptor blockade. Androgen receptor mediated metabolic responses act as an important driver towards maintaining both physical and mental health in men [ 5 , 15 , 16 ]. Several cohort and cross section studies have shown an association between lower serum testosterone (a principal male sex hormone which binds to the androgen receptor) levels and a higher metabolic syndrome percentage and cardiovascular morbidity [ 17 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

Conventional androgen deprivation therapy is associated with an increased risk of cardiovascular disease in advanced prostate cancer, a nationwide population-based study

Wang

Chen

et al. 2022

PLoS ONE

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Purpose Androgen Deprivation Therapy (ADT) is the mainstay treatment in advanced prostate cancer. We conducted a nationwide population-based study to evaluate the association of ADT and cardiovascular diseases. Methods Between 2005 and 2009, patient data from the National Health Insurance database were obtained. We divided newly diagnosed prostate cancer patients into four groups, injection of gonadotropin-releasing hormone agonists and antagonists, oral antiandrogens, orchiectomy and radical prostatectomy only. Another matched non-cancerous control group was also assigned for comparison purposes. Study outcomes were newly onset Cardiovascular Diseases (CVD) and hospital admissions. Multi-variant Cox proportional regression analysis and the Kaplan–Meier method for cumulative incidence were performed. Results A total of 17,147 newly diagnosed prostate cancer patients were found. After exclusion criteria was considered, the 2,565 remaining patients were then divided into 1,088 subjects in the injection group, 286 in the orchiectomy group, 812 in the oral group and 379 in the radical prostatectomy only group. The mean age of all the patients was 71.2 years. Multi-variant analysis showed a significantly increased risk of CVD in the injection group, orchiectomy group, oral group and radical prostatectomy group (HR = 2.94, 95% CI 2.51 to 3.45, p<0.001, HR = 3.43, 95% CI 2.69 to 4.36, p<0.001, HR = 2.87, 95% CI 2.42 to 3.39, p<0.001, HR = 1.93, 95% CI 1.5 to 2.48, p<0.001, respectively). A time dependent increased risk of CVD was also observed amongst the study groups (p<0.001). Conclusions ADT is associated with an increased risk of CVD. For long-term prostate cancer castration therapy, doctors should be aware of this complication and arrange for proper management.

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Section: Discussionmentioning

confidence: 99%

Conventional androgen deprivation therapy is associated with an increased risk of cardiovascular disease in advanced prostate cancer, a nationwide population-based study

Wang

Chen

et al. 2022

PLoS ONE

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“…АГ и СД в сочетании с химиотерапией значительно повышают риск развития таких неблагоприятных сердечно-сосудистых событий, как инсульт, инфаркт миокарда и застойная сердечная недостаточность [13]. При раке предстательной железы также часто имеют место ССЗ, которые могут прогрессировать в ходе андрогендепривационной терапии [14]. Риск смерти от ССО у пациентов с ЗНО предстательной железы превышает аналогичный риск в общей популяции в 4-6 раз [15].…”

Section: цель консультацииunclassified

Telehealth consultations in cardio-oncology

Potievskaya

Kononova

Shaputko³

et al. 2022

Cardiovasc Ther Prev

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Aim. To evaluate the role of a cardiologist in telehealth counseling of cancer patients at the federal oncology center.Material and methods. This retrospective study was conducted based on the materials of 215 telehealth consultations on cardiooncology, performed in the period from January 2019 to September 2021. Data on referrals to a cardiologist (cardio-oncologist) from various Russian regions and consultants’ answers were analyzed, taking into account the following data: region, sex, age of a patient, cancer type, stage, participation of other consultants, type of cardiovascular disease, the need for additional information and features of treatment — surgery, chemotherapy, radiation therapy. Risk was stratified based on a checklist including the main risk factors for cardiotoxicity. The recommendations of consultants for monitoring patients, as well as drug therapy prescriptions, were analyzed.Results. The most common cancer sites in patients referred for telehealth consultations on cardio-oncology were lungs, larynx and trachea, colon and rectum, kidneys and bladder, ovaries and uterus, and stomach. Cardiologists consulted together with oncologists — surgeons, medical oncologists, as well as anesthesiologists and radiation oncologists. The most common cardiovascular diseases were hypertension — 80,9% of patients, heart failure — 60%, arrhythmias — 41,6% and coronary heart disease — 37,7%. From 71 to 80,3%, 15,6-21% and 3,9-7,8% of patients had preserved, mid-range and reduced left ventricular ejection fraction. In 47,6-66,7% of cases, consultants required additional information. Based on risk stratification of cardiotoxicity of anticancer treatment, 118 (81,9%) patients out of 144 were classified as high and very high risk. Most patients were recommended cardioprotective therapy, which most often included angiotensin-converting enzyme inhibitors/angiotensin receptor blockers — 43,1-53,1%, beta-blockers — 44,8-58,6%, and statins — 22,4-38,3%. An algorithm for creating a request for a cardio-oncology telehealth consultation has been developed.Conclusion. The important role of cardio-oncology telehealth consultations in the work of the federal oncology center is demonstrated. Consulting cardiologists are part of a single multidisciplinary team of specialists and must act taking into account the characteristics of cancer and antitumor therapy prescribed by oncologists.

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“…Increased vascular tone Decreased activation of nitric oxide synthase in endothelial cells [33,34] Decreased downregulation of L-type voltage-gated calcium channels and decreased upregulation of calcium-activated potassium channels on vascular smooth muscle cells [35,36] Vascular remodeling Increased intima--media thickness [37,38] Increased vascular calcification [35,38,39] Decreased antisenescence effect of testosterone [40] Systemic inflammation and atherosclerosis lesion formation The risk of cardiac events appears to be related to duration of treatment, with one trial demonstrating a 6% increase in number of cardiac events associated to long-term treatment (28 months; 20%) as opposed to short-term (4 months; 14%) [52].…”

Section: Vascular Effects Pathophysiologymentioning

confidence: 99%

Cardiometabolic side effects of androgen deprivation therapy in prostate cancer

Lafontaine

Kokorovic

2022

Current Opinion in Supportive &Amp; Palliative Care

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Purpose of reviewAndrogen-deprivation therapy (ADT) is widely employed for treatment of advanced prostate cancer and it is considered the frontline therapy. However, the numerous adverse reactions associated with this treatment option are concerning and its potential association with cardiovascular diseases (CVD) should not be overlooked. In this review, we examine the literature on the cardiovascular side effects of ADT and the physiologic mechanisms underpinning the association with CVD. We will also specifically discuss the different findings regarding the interesting potential disparity in major cardiovascular events among GnRH agonist-treated patients compared with patients undergoing GnRH antagonist treatment.Recent findingsAndrogen-deprivation therapy increases the risk of developing CVD by altering the body composition, metabolism, vascular system, and cardiac physiology. GnRH agonists may pose a higher risk of cardiovascular mortality and morbidity than GnRH antagonists; however, this link remains to be determined. Furthermore, screening for cardiovascular risk factors before and during ADT treatment is a crucial step in preventing major adverse cardiac events in prostate cancer patients. Notably, preexisting CVD and comorbidities have been identified as major key elements predicting cardiovascular events. Early implementation of pharmacological and nonpharmacological treatment strategies is strongly suggested, and regular follow-up visits should be scheduled to continuously assess patients’ cardiovascular risk under ADT.SummaryADT is a very powerful treatment option for advanced prostate cancer that improves survival outcomes but has the potential of considerably impacting patients’ cardiovascular health. Medical optimization and close monitoring are crucial during treatment with ADT.

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Cardiovascular Complications of Prostate Cancer Treatment

Cited by 21 publications

References 86 publications

Conventional androgen deprivation therapy is associated with an increased risk of cardiovascular disease in advanced prostate cancer, a nationwide population-based study

Conventional androgen deprivation therapy is associated with an increased risk of cardiovascular disease in advanced prostate cancer, a nationwide population-based study

Telehealth consultations in cardio-oncology

Cardiometabolic side effects of androgen deprivation therapy in prostate cancer

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