Megha Agarwal1, Timothy Canan2, Greg Glover3, Nidhi Thareja4, Andre Akhondi2, Joshua Rosenberg5. 1. Cardiology, UCLA Health Ventura, 6633 Telephone Rd. Suite 120, Ventura, CA, 93003, USA. magarwal@mednet.ucla.edu. 2. Cardiology, UCLA Health Ventura, 6633 Telephone Rd. Suite 120, Ventura, CA, 93003, USA. 3. Cardiology, UCLA Health Simi Valley, 2655 First Street Suite 360, Simi Valley, CA, 93065, USA. 4. Cardiology, UCLA Health Downtown Los Angeles, 1400 South Grand Ave. Suite 605, Los Angeles, CA, 90015, USA. 5. Oncology, UCLA Health Ventura, 6633 Telephone Rd. Suite 200, Ventura, CA, 93003, USA.
Abstract
PURPOSE OF THE REVIEW: This review paper is a comprehensive look at the cardiovascular disease (CVD) risk that is associated with the use of androgen deprivation therapy in prostate cancer. It summarizes when certain cancer therapies are indicated and should guide physicians in identifying patients at increased risk for CVD during prostate cancer therapy. RECENT FINDINGS: GnRH agonist use and maximal androgen blockade (MAB) are associated with increased CVD. This association is not observed in patients on GnRH antagonists. One example is the novel agent abiraterone, which is associated with hypertension whose mechanisms are likely driven by mineralocorticoid excess. Incidence of cardiovascular disease events is greatest when using MAB, especially in patients with pre-existing CVD. There is significant confounding that exists given patients with more aggressive cancers tend to be older and have more co-existing CVD. Given the lower CVD event rates with GnRH antagonists, future studies and strategies should focus on high-risk cancer patients with co-existing CVD receiving antagonists over agonists.
PURPOSE OF THE REVIEW: This review paper is a comprehensive look at the cardiovascular disease (CVD) risk that is associated with the use of androgen deprivation therapy in prostate cancer. It summarizes when certain cancer therapies are indicated and should guide physicians in identifying patients at increased risk for CVD during prostate cancer therapy. RECENT FINDINGS:GnRH agonist use and maximal androgen blockade (MAB) are associated with increased CVD. This association is not observed in patients on GnRH antagonists. One example is the novel agent abiraterone, which is associated with hypertension whose mechanisms are likely driven by mineralocorticoid excess. Incidence of cardiovascular disease events is greatest when using MAB, especially in patients with pre-existing CVD. There is significant confounding that exists given patients with more aggressive cancers tend to be older and have more co-existing CVD. Given the lower CVD event rates with GnRH antagonists, future studies and strategies should focus on high-risk cancerpatients with co-existing CVD receiving antagonists over agonists.
Authors: Frederik Birkebæk Thomsen; Fredrik Sandin; Hans Garmo; Ingela Franck Lissbrant; Göran Ahlgren; Mieke Van Hemelrijck; Jan Adolfsson; David Robinson; Pär Stattin Journal: Eur Urol Date: 2017-07-12 Impact factor: 20.096
Authors: Laurence Klotz; Laurent Boccon-Gibod; Neal D Shore; Cal Andreou; Bo-Eric Persson; Per Cantor; Jens-Kristian Jensen; Tine Kold Olesen; Fritz H Schröder Journal: BJU Int Date: 2008-12 Impact factor: 5.588