ADT May Increase Risk of Death From Cardiovascular Disease in Prostate Cancer

Androgen deprivation therapy (ADT) may increase the risk of death from cardiovascular disease (CVD) in patients with prostate cancer, according to research published in The Aging Male.

Researchers found an elevated risk of CVD-related death in patients treated with ADT, regardless of the duration of therapy. The risk was highest in the first 4 years after diagnosis, and older patients had the greatest risk of CVD-related mortality.

Data for this study were sourced from the Lithuanian Cancer registry and included men ages 40-79 years who were diagnosed with prostate cancer from 2012 through 2016. 

The researchers evaluated 13,343 patients for CVD-related mortality risk through 2019 on the basis of receiving ADT or not. ADT consisted of gonadotropin-releasing hormone agonists and antiandrogens. Patients in the non-ADT group underwent radiotherapy and surgery.

There were 3797 patients who received ADT and 9546 patients who did not. The mean ages at diagnosis were 67.86 years and 63.47 years, respectively (P <.05). The mean follow-up was 4.63 years and 5.13 years, respectively (P <.05). 

Organ-confined disease was seen in 29.21% of the ADT cohort and 60.15% of the other cohort (P <.05). Locally advanced disease was seen in 34.55% and 8.10%, respectively (P <.05). Distant disease was seen in 7.98% and 0.88%, respectively (P <.05).

In an unadjusted analysis, ADT use was associated with an increased risk of CVD-related mortality (hazard ratio [HR], 2.14; 95% CI, 1.86-2.45; P <.001). The risk remained elevated after the researchers adjusted for patient age and disease stage (adjusted HR [aHR], 2.03; 95% CI, 1.65-2.51; P <.001).

The risk of CVD-related mortality was elevated regardless of the duration of ADT. Patients had an increased risk of CVD-related mortality if they received ADT for 4-40 weeks (aHR, 1.75; 95% CI, 1.42-2.15; P <.001), 44-104 weeks (aHR, 1.35; 95% CI, 1.08-1.68; P =.009), or more than 108 weeks (aHR, 1.51; 95% CI, 1.22-1.87; P <.001).

The risk of CVD-related mortality was highest in the first 4 years after diagnosis (aHR, 2.01; 95% CI, 1.39-2.91; P <.001). The risk was also elevated in the first 3 years (aHR, 1.94; 95% CI, 1.34-2.83; P =.001), the first 2 years (aHR, 1.67; 95% CI, 1.14-2.45; P =.008), and more than 5 years from diagnosis (aHR, 1.41; 95% CI, 1.07-1.85; P =.014).

Older patients had the greatest risk of CVD-related mortality, specifically those 70-79 years of age (aHR, 4.78; 95% CI, 3.79-6.04; P <.001) and 60-69 years (aHR, 2.29; 95% CI, 1.80-2.91; P <.001).

The researchers also assessed the risk of death associated with specific CVD events. The team found that ADT recipients had a significantly increased risk of death from stroke (aHR, 1.70; 95% CI, 1.18-2.45; P =.005) and ischemic heart disease (aHR, 1.42; 95% CI, 1.16-1.73; P =.001) but not from other CVD events.

A major limitation of this study was the lack of data about pre-existing CVD conditions. Nevertheless, the researchers concluded that using ADT for the treatment of prostate cancer was associated with an increased risk of CVD-related mortality, particularly for older patients. 

Reference

Jonušas J, Drevinskaitė M, Patašius A, Kinčius M, Janulionis E, Smailytė G. Androgen-deprivation therapy and risk of death from cardio-vascular disease in prostate cancer patients: A nationwide Lithuanian population- based cohort study.Aging Male. Published online July 26, 2022. doi:10.1080/13685538.2022.2091130

This article originally appeared on Cancer Therapy Advisor