Cardiovascular Toxicities of ADT

Cardiovascular Toxicities of Androgen Deprivation Therapy (2021, Review, Full Text)

"Opinion statement
Prostate cancer is the second leading cause of cancer death in men, and cardiovascular disease is the number one cause of death in patients with prostate cancer. Androgen deprivation therapy, the cornerstone of prostate cancer treatment, has been associated with adverse cardiovascular events. Emerging data supports decreased cardiovascular risk of gonadotropin releasing hormone (GnRH) antagonists compared to agonists. Ongoing clinical trials are assessing the relative safety of different modalities of androgen deprivation therapy. Racial disparities in cardiovascular outcomes in prostate cancer patients are starting to be explored. An intriguing inquiry connects androgen deprivation therapy with reduced risk of COVID-19 infection susceptibility and severity. Recognition of the cardiotoxicity of androgen deprivation therapy and aggressive risk factor modification are crucial for optimal patient care.
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Conclusion and future directions
ADT-associated cardiotoxicity is linked to increased morbidity and mortality in patients with prostate cancer. Nevertheless, promising data are emerging regarding the improved safety of GnRH antagonists. The risk-benefit ratio between GnRH agonists and antagonists should be carefully considered. It is imperative to identify, monitor, and manage CV risks and complications in prostate cancer patients, especially in older patients with a prior history of significant CVD. The striking racial disparity in prostate cancer mortality among blacks compared to all other races, plus their high mortality from CV disease, warrants prompt attention by the research community. The need for novel strategies to maximize enrollment of these high-risk populations into clinical trials for prostate cancer therapy cannot be overemphasized. More high-quality trials that directly examine adverse CV events as a primary endpoint are needed. Despite the associated cardiotoxicity, ADT intriguingly may confer protection against COVID-19 infection through limiting the virus’ entry into cells."

(See Full Text and Table 1, GnRH agonists versus antagonists: comparison of cardiovascular risk)

Djin

Thanks Djin, i will def read the referred link, this is an issue for me as well. During my Lupron treatment, my Triglycerides skyrocketed, and only now, two years after treatment ended am i getting it somewhat under control. I have heart disease and i believe high TG which i have always struggled with but never to the extent as i did while on Lupron, is the cause. So this is an issue near and dear to my heart, no pun intended

TJ, The Orgovyx trial noted a slightly lower incidence than Lupron. However Firmagon trials also reported a lower incidence than Lupron. So we have for some time had a drug in the ADT/gNRH class that reports lower cardiovascular disease incidence than Lupron. Remember the lower incidence reported was limited to the period of the trial. These men are not followed for their lifetime so just because the incidence was lower during the trial doesn’t mean that the lower incidence would continue after the drug is stopped.

However, the real key is the effect of the no T rather than the process that gets you there. Men who have an orchiectomy also experience increased cardiovascular disease and never took any ADT drugs.

Now that these drugs are being used to lower the testosterone in transsexual males transitioning, it will be interesting to see the long term effects. Most men that use ADT drugs for PCa do so for a relatively short time of 1-3 years. Longer term use is much less common and often stops when the PCa becomes refractory. Also the age of use is more in the 55-75 range. Contrast that to adolescents who start in their teens and plan on using these drugs indefinitely, or submit to an orchiectomy at a relatively young age, which could be 50 years or more. I wonder to what extent the doctors are warning of potentially increased cardiovascular disease when counseling on the use of these drugs.