Cardiovascular mortality in patients with prostate cancer exposed to androgen deprivation therapy.
BACKGROUND
A relationship between the administration of GnRH agonists and the risk of acute myocardial infarction (AMC) in patients with prostate cancer has been showed in the third observational study published in April 2014. The association AMC-orchiectomy was not found in any of these studies.


OBJECTIVE
Define risk factors for cardiovascular disease in patients treated with GnRH agonist. Their probable underlying pathogenic mechanism in the myocardium and peripheral vascular tree was also analyzed.


METHODS
English articles cited in PubMed were reviewed. No time period is specified. The last search date was 11/30/14.


RESULTS
In patients with coronary history of AMC or congestive heart failure, hormonal neoadjuvant therapy increased cardiovascular mortality rates (HR: 1.96, IC 95%: 1.04-3.71; P=.04) as well as cardiovascular-specific mortality rates (AHR: 3.28; IC 95%: 1.01-10.64; P=.048). Two possible mechanisms can be involved: a) direct mechanism through myocardial receptor for GnRH/PKA along with atherogenic plaques; and b) indirect mechanism related with metabolic disturbances.


CONCLUSIONS
Patients with AMC or congestive heart failure history could present a higher risk of death related to the use of GnRH agonists. In these cases, should carefully consider appropriateness of such treatment. These effects can explained by a direct mechanism on myocardium and peripheral vascular tree and indirect ones related with modified metabolic syndrome.
Servicio Urología, Hospital Dr. Federico Abete, Buenos Aires, Argentina. Electronic address: juanimonzo@hotmail.com.
J I
JI
Monzó-Gardiner
Servicio Urología, Hospital General Universitario Gregorio Marañón, Madrid, España.
F
F
Herranz-Amo
D000726:Androgen Antagonists / Q000009:adverse effects* / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality*; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists*; D006801:Humans; D008297:Male; D011471:Prostatic Neoplasms / Q000188:drug therapy*
D000726:Androgen Antagonists; D007987:Gonadotropin-Releasing Hormone
Agentes hormonales antineoplásicos; Antienoplastic agents, hormonal; Cardiovascular disease; Cáncer de próstata; Enfermedad cardiovascular; Metabolic Syndrome X; Prostatic neoplasm; Síndrome metabólico