CVD risk underappreciated in men treated with AST
MedWire News: Cardiovascular disease (CVD) risk is an underappreciated complication in men undergoing androgen suppression therapy (AST) for prostate cancer, according to experts.
"The adverse effects of AST will lead to additional patient CVD morbidity/mortality and as such will likely generate additional costs associated with secondary treatments," write Derek Rosario (University of Sheffield, UK) and colleagues in a viewpoint article published in the journal Heart.
The main treatment for prostate cancer is AST, with data also supporting its use for men with symptomatic skeletal metastases, lymphatic metastases, and when combined with radiotherapy in locally advanced disease.
AST reduces the risk for prostate cancer-specific mortality, but does so at an increased risk for nondisease specific mortality. Evidence is growing to also suggest a significantly increased risk for CVD morbidity and mortality.
For example, a pooled analysis from three randomized trials showed that the use of AST was linked with higher rates of myocardial infarction in men aged 65 years and older.
Data from a large registry also showed that the use of gonadotrophin-releasing hormone (GnRH) was associated with a significant 28% higher incidence of diabetes, a 19% higher incidence of coronary heart disease, and 28% higher incidence of myocardial infarction than nonuse.
In addition, use of AST was associated with higher rates of cardiac death and stroke.
"Although the weight of evidence suggests a link between AST and CVD, it is still unclear whether this reflects a causal relationship," say Rosario and colleagues.
Outside the use of AST in prostate cancer, the researchers note that there have been studies showing that low levels of AST are associated with an increased risk for CVD.
They estimate that for every 1000 men treated for 5 years with AST, there will be an excess of 315 incident cases of coronary heart disease, 360 cases of diabetes, 28 myocardial infarctions, and 42 strokes.
They urge clinicians to consider patient comorbidities when starting AST and to stress the cardioprotective benefits of regular exercise and a healthy diet. They add that men starting AST might be candidates for statin therapy.
To date, however, there have been no attempts in the UK to address the increased risk for CVD associated with AST. The researchers concede that while the association between AST use and CVD morbidity/mortality has been challenged, the current status quo is unsatisfactory for patients and unlikely to be cost effective.
"As a consequence, there is a need to investigate integration of AST specific CVD risk augmentation strategies into standard clinical care," conclude Rosario et al.
By MedWire Reporters