Cardiovascular risk with androgen deprivation therapy

Abstract

Summary Background From the primary care perspective, many urologists and oncologists appear to be ignoring an FDA warning to assess patients' cardiovascular (CV) risk before instituting androgen deprivation therapy (ADT) with gonadotropin‐releasing hormone (GnRH) agonists. A growing body of data suggest an association between ADT and CV/cardiometabolic risk, particularly for GnRH agonists. Methodology The author examined available evidence regarding CV side effects with GnRH agonists and antagonists to determine what urologists, medical oncologists, primary care physicians (PCPs) and patients need to know about these risks. Results Data are inconclusive and somewhat conflicting—for example, both low testosterone and testosterone replacement have been associated with elevated CV risk. But the distinction between GnRH agonists and antagonists is becoming clearer, as agonists appear to be more strongly linked with CV risk, perhaps due to the transient testosterone surge they cause upon administration. Moreover, adverse CV events associated with GnRH agonists can emerge relatively quickly, within weeks to months. Conversely, two studies show that GnRH antagonists may significantly reduce CV risk compared to GnRH agonists. Conclusions Both GnRH agonists and antagonists carry some degree of CV risk. Although the risk appears to be lower with GnRH antagonists, urologists and oncologists should communicate with PCPs to determine patients' baseline CV risk levels before implementing ADT with either type of agent.

The Use of Androgen Deprivation Therapy for Prostate Cancer Lead to Similar Rate of Following Open Angle Glaucoma: A Population-Based Cohort Study

“…Moreover, the correlation between OAG and ischemic stroke or coronary heart disease had been demonstrated in previous researches [17,18]. ADT can lead to a higher rate of cardiovascular disorders and related mortality [19], and a previous study showed that the incidence of OAG decreased in prostate cancer patients who received ADT therapy [20]. Accordingly, ADT may have the chance to alter the rate of OAG; however, further research is needed to confirm this.…”

Review of Cardiovascular Risk of Androgen Deprivation Therapy and the Influence of Race in Men with Prostate Cancer

“…Larger-scale trials and longer follow-up with more in-depth patient demographics and risk factors will be needed to fully understand the present risk of ADT [ 32 ]. As of now, official guidelines have only come from the FDA, who in October 2010, determined that the available evidence showed a small but significant increase in risk of CV events and mandated labels on GnRH agonists to show safety information regarding its CV risks [ 38 ].…”