Prolonged Androgen Deprivation Therapy Increases Risk of CV Death in Prostate Cancer Patients

An association between prolonged androgen deprivation therapy (ADT) and reduced cardiovascular (CV) fitness and increased risk of cardiovascular death was identified in patients with prostate cancer having underlying cardiovascular disease.

Jingyi gong, MD sought to examine the impact of ADT exposure & duration of exposure - short term (< 6 months) and prolonged exposure (> 6 months)on the cardiorespiratory fitness and cardiovascular mortality. The study findings revealed that the use of ADT regimens increased- longer duration and increased intensity of therapy.

‘Prolonged ADT exposure had an association with reduced cardiovascular fitness increased cardiovascular mortality. In patients with short term ADT exposure, the association of the reduced cardiovascular fitness was borderline and thus no association link with cardiovascular mortality. ’

The study cohort had 616 patients enrolled who underwent a exercise treadmill test (ETT) for clinical indications from March 7, 2002 & August 18, 2005. The median time from the prostate cancer diagnosis to ETT was 4.8 years. Cardiorespiratory fitness was calculated from peak treadmill speed & the grade achieved during the ETT.

Approximately one quarter (150) of patients had received ADT- 99 had long term exposure & 51 had short term exposure. Majority of patients with long term exposure to ADT had more than two cardiovascular risk factors.

The study results indicated that prolonged ADT exposure had an association with reduced cardiovascular fitness & increased cardiovascular mortality.

In patients with short term ADT exposure, the association of the reduced cardiovascular fitness was borderline & thus no association with cardiovascular mortality.

"While prolonged ADT certainly plays a role in the treatment of prostate cancer, these findings emphasize the need to consider cardiovascular surveillance/risk modification during and after ADT exposure," said study author John D. Groarke, MBBCh, MSc, MPH.

Vivek K. Narayan, MD, MSCE and Alicia K. Morgans, MD, MPH,conclude by saying " By improving our understanding of the patient- and treatment-related factors contributing to ADT-related cardiac toxicity, oncology and cardiology providers can work collaboratively to optimally employ therapy modifications and cardiovascular risk mitigation strategies,"


Source: Medindia