DALLAS, Feb. 1 — Androgen-deprivation therapy (ADT), commonly used to treat prostate cancer, can worsen heart risk factors and may increase the risk of heart attack and/or cardiac death, although the relationship between ADT and heart attack or cardiac death has not been definitively established, according to a science advisory published in Circulation: Journal of the American Heart Association.
The advisory, produced by a writing group of experts from the American Heart Association, American Cancer Society, American Urological Association and American Society for Therapeutic Radiology and Oncology, is an evaluation of published research about the relationship between ADT and cardiovascular events and risk factors in patients with prostate cancer.
Considerable data show that ADT can increase fat mass, increase low-density lipoprotein (LDL) cholesterol — the “bad” cholesterol — and cause blood sugar abnormalities, according to the writing group.
“Based on current data, it was appropriate to conclude that there may be a relationship between ADT therapy in patients with prostate cancer and future cardiovascular risk,” said Glenn N. Levine, M.D., chair of the advisory writing group and professor of medicine at Baylor College of Medicine in Houston.
While some studies have found an association between ADT and increased cardiovascular risk, other studies have not detected the association, according to the advisory. The writing group called for future studies to prospectively analyze heart risks related to ADT whenever possible.
An increased risk with ADT was noted in 1 percent to 6 percent of the study populations. Thus, “while there may be some increased heart risk, the decision about whether to initiate ADT should be based on weighing the benefits of therapy with this potential modest risk,” he said.
Decisions about ADT should be made by the physician treating the patient for prostate cancer without referral to other specialists, according to the advisory. However, given the metabolic effects of ADT therapy, patients receiving ADT should be followed periodically by their primary care physicians. Patients with known heart disease should always be encouraged to adopt healthy lifestyle changes and receive the appropriate preventive therapies if necessary, including lipid-lowering, blood pressure-lowering, glucose-lowering therapy and antiplatelet therapies (such as aspirin), Levine said.
Co-authors include: Anthony V. D’Amico, M.D., Ph.D.; Peter Berger, M.D.; Peter E. Clark, M.D.; Robert H. Eckel, M.D.; Nancy L. Keating, M.D., M.P.H.; Richard V. Milani, M.D.; Arthur I. Sagalowsky, M.D.; Matthew R. Smith, M.D., Ph.D.; and Neil Zakai, M.D.
Author disclosures are on the manuscript.
About the American Urological Association
Founded in 1902 and headquartered near Baltimore, Maryland, the American Urological Association is the pre-eminent professional organization for urologists, with more than 16,000 members throughout the world. An educational nonprofit organization, the AUA pursues its mission of fostering the highest standards of urologic care by carrying out a wide variety of programs for members and their patients. For more information, please call 1-866-RING-AUA (1-866-746-4282) or visit www.AUAnet.org.
About the American Cancer Society
The American Cancer Society saves lives and creates a world with less cancer and more birthdays by helping you stay well, helping you get well, by finding cures and fighting back. As the nation’s largest non-governmental investor in cancer research, contributing about $3.4 billion, we turn what we know about cancer into what we do. To learn more about us or to get help, call 1-800-227-2345 or visit www.cancer.org.
About the American Heart Association
Founded in 1924, we’re the nation’s oldest and largest voluntary health organization dedicated to building healthier lives, free of heart disease and stroke. To help prevent, treat and defeat these diseases — America’s No. 1 and No. 3 killers — we fund cutting-edge research, conduct lifesaving public and professional educational programs, and advocate to protect public health. To learn more or join us in helping all Americans, call 1-800-AHA-USA1 or visit americanheart.org.
The American Heart Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing science content. Revenues from pharmaceutical and device corporations are available at www.americanheart.org/corporatefunding.
Wendy Isett, AUA