Androgen deprivation therapy increases cardiovascular morbidity in men with prostate cancer.
BACKGROUND
The use of androgen deprivation therapy (ADT) in the treatment of men with prostate cancer has risen sharply. Although cardiovascular disease is the most common reason for death among men with prostate cancer who do not die of the disease itself, data regarding the effect of ADT on cardiovascular morbidity and mortality in men with prostate cancer are limited. In the current study, the authors attempted to measure the risk for subsequent cardiovascular morbidity in men with prostate cancer who received ADT.


METHODS
A cohort of newly diagnosed men in a population-based registry who were diagnosed between 1992 and 1996 were identified retrospectively. A total of 22,816 subjects were identified after exclusion criteria were applied. Using a multivariate model, the authors calculated the risk of subsequent cardiovascular morbidity in men with prostate cancer who were treated with ADT, as defined using Medicare claims.


RESULTS
Newly diagnosed prostate cancer patients who received ADT for at least 1 year were found to have a 20% higher risk of serious cardiovascular morbidity compared with similar men who did not receive ADT. Subjects began incurring this higher risk within 12 months of treatment. However, Hispanic men were found to have a lowered risk for cardiovascular morbidity.


CONCLUSIONS
ADT is associated with significantly increased cardiovascular morbidity in men with prostate cancer and may lower overall survival in men with low-risk disease. These data have particular relevance to decisions regarding the use of ADT in men with prostate cancer in settings in which the benefit has not been clearly established. For men with metastatic disease, focused efforts to reduce cardiac risk factors through diet, exercise, or the use of lipid-lowering agents may mitigate some of the risks of ADT.
Saigal
Christopher S
CS
Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California 90095, USA. csaigal@mednet.ucla.edu
Gore
John L
JL
Krupski
Tracey L
TL
Hanley
Janet
J
Schonlau
Matthias
M
Litwin
Mark S
MS
D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000008:administration & dosage / Q000009:adverse effects*; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000139:chemically induced / Q000401:mortality*; D015331:Cohort Studies; D004522:Educational Status; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D006278:Medicare; D015999:Multivariate Analysis; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000208:ethnology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D018426:SEER Program; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology
D000726:Androgen Antagonists; D018931:Antineoplastic Agents, Hormonal