HEART ATTACK RISK ASSOCIATED WITH ADT...

[Tommyj2]

Anyone have real data re: true risk of heart attack as a result of ADT....All my life I have had high cholesterol....diet makes little difference...refused Statins. My Calcium Score is presently Zero ( or WAS 2 years ago).... Will probably consider a statin as part of pca protocol.... Will be starting ADT in a week or two and don't want to be stupid about it but also don't want to turn my whole world upside down if these changes in Cardiac Markers don't objectively translate into heart attacks.....

[tango65]

Here is some info. If you are preoccupied about the cardiovascular effects of ADT, you could consider to use Firmagon instead of Lupron:

ncbi.nlm.nih.gov/pmc/articl...

healthunlocked.com/advanced....

ncbi.nlm.nih.gov/pubmed/242...

[FCoffey]

Try going to pubmed.gov and putting the title of your post into the query box.

Here's what turned up when I did that:

This 2015 paper

ncbi.nlm.nih.gov/pubmed/251...

finds that

After a median follow-up of 4.8 years, no association was detected between ADT and CSM in men with no cardiac risk factors

CSM means Cardiac-Specific Mortality, death from heart attacks

or in men with diabetes mellitus, hypertension, or hypercholesterolaemia

(high cholesterol) so it sounds like you aren't at significantly elevated risk.

ADT was associated with significantly increased CSM in men with CHF or MI

congestive heart failure (CHF) or past myocardial infarction (MI).

This 2016 paper found differently:

ncbi.nlm.nih.gov/pubmed/260...

patients receiving GnRH agonists were more likely to experience a cardiac event, with the most pronounced effect among those receiving ≥8 doses

GnRH agonists are the drugs like Lupron. They found about 15% increase in risk for cardiac events.

And this 2016 paper

ncbi.nlm.nih.gov/pubmed/273...

found a significant difference between GnRH agonists and anti-androgens such as Zytiga:

antiandrogen was associated with a 30% decrease risk for myocardial infarction (MI) compared to GnRH agonists

combined androgen blockade (CAB) was associated with a 10% increase risk for stroke when compared to antiandrogen

The paper notes that it is difficult to measure these effects and more data and study is required.

[Tommyj2 in reply to FCoffey]

Thank you for this information..... as appears to be the case with EVERYTHING in this becursed disease there are no really clear guidelines....toss your hat into the ring and hope that you are one of the lucky ones that does not become a negative statistic.......

[cesanon]

Best thing to do is mix in some light non-aerobic exercise as best you can.

[j-o-h-n in reply to cesanon]

As per your request: "stop reading my posts please. Thanks" I did not read your post.

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 07/10/2019 10:00 PM DST

[EdBar]

Adding a cardiologist to your team might be a good idea if you don’t already have one. I was reluctant to at first but at the urging of my better half I now visit the cardiologist a couple times a year. Gotta cover all the bases, I’ve been on ADT for 5+ years.

Ed

[Tommyj2 in reply to EdBar]

How is the ADT working for you/? What regimen are you on??

any alteration in Cardiac profile??

[EdBar in reply to Tommyj2]

I’ve been on triple ADT since dx. Lupron, Casodex, switched to Xtandi about 4 years ago and Avodart since dx - Snuffy Myers regimen. So far so good PSA is undetectable for almost 5 years now. I also had chemo per CHAARTED and radiated my prostate and several nodes early on.

No real alteration in cardiac profile, had a nuclear stress test and checked out fine. I’ve taken a statin for years and still do. Snuffy switched my statin to Crestor when I started seeing him, he said some statins can interfere with pathways xtandi uses.

I’ve been on BP meds for many years. Eat a healthy Mediterranean diet and exercise daily, gotta keep the machine in good working order to fight the fight.

Ed

[Tommyj2 in reply to EdBar]

If you don't mind me asking....how old are you now?

[EdBar in reply to Tommyj2]

60

[Tommyj2 in reply to EdBar]

Thanks Ed..... sorry you got this damned disease when you were so young.

[GeorgeGlass in reply to EdBar]

Did you go to xtandi while you were still responsive to Lupron alone?

[EdBar in reply to GeorgeGlass]

Yes part of the Snuffy Myers protocol, hit it early with all you got.

[GeorgeGlass in reply to EdBar]

I wish there was a hard study showing which way is best. Subsequent vs sequential. Quality of life is another factor.

[EdBar in reply to GeorgeGlass]

I’m sure those studies are out there. The philosophy of hit it hard and early is to try and eliminate the cancers ability to mutate and spread, and drive it into a dormant stage were it can be kept under control through standard treatments. That’s the one I chose and so far so good, and I still have a good QOL, it’s different but good.

[GeorgeGlass in reply to EdBar]

I can understand that Ed. I talked to my mo about this many times. He's at Duke and wants me to save my bullets. I think the main reason is that i have coronary artery disease and is afraid of effects on my heart arteries etc from zytiga xtandi etc. He worried about by heart on intermittent lupron as well but i thought intermittent might keep my bones and joints stronger with the intermittent Testosterone. I'm not sure if this is the best option but so far in doing ok after four years. Let's hope we both continue to do well

[TEBozo]

Take the statin

[JuanVV]

If it's any help, my husband took Firmagon versus Lupron because of his heart condition, and it didn't produce any major changes to his heart. Now he's on Xtandi since Firmagon stopped working.

[Tommyj2 in reply to JuanVV]

Thank you for the reply. On the plus side I don't have any heart condition YET. What I DO have is an extremely limited budget and the very real possibility of bankruptcy if I use many of the drugs that are currently being recommended by so many..... for the present I can use the old line drugs and hope that they don't cause too many problems..... with luck ..later on I can try to get Pharm assistance from the manufacturer....

[JuanVV]

And he reasearched best ADT for heart himself and found Firmagon as the best option for him, his second doctor (first didn't ,wanted him to go on Eligard) agreed.

[Advo__cate]

My husband's experience - mild CVD noted on first ct scan, lupron started at this time. Severe CVD on scan 6 months later. His cholesterol remained in normal ranges throughout ADT.

Get an ADT literate cardiologist on board, take the statin (my husband is on atoravastin) to keep the ldl low, stick with firmagon. Exercise, diet, supplements can only go so far when combatting the CVD acceleration of ADT/lupron in some men.

[Tommyj2 in reply to Advo__cate]

Thank you for the information and advice.... I'll be taking whatever drug is recommended AND covered by part B medicare initially... I don't have the money for the expensive oral meds and it will take some time to get manufacturers assistance if I can get it at all....

[Break60]

Use a statin !! With high cholesterol and ADT , CV risk is higher.

[Summm]

When it comes to choose between firmagon and lupron, firmagon is a safer choice , as told by our MO, since my dad too had cardiac issues. Also for next level of ADT's that is between Xtandi and Zytiga, Xtandi remains a preffered option.

[Tommyj2 in reply to Summm]

It's going to have to be a BIG difference for me to pay 600.00 out of pocket for firmagon vs nothing for Lupron.... my part D insurance is all but useless for most of the drugs not covered by Medicare B.

My Risk factors fortunately are just that...potential risk factors.... I do not currently have any cardiac issues.... Guess if I develop them I'll have to switch if it's show that there is a DECIDED difference....

thank you for the input....

[Summm in reply to Tommyj2]

I would suggest to seek a cardiologist opinion alonh with MO to see if statins with lupron work well- which should i believe.

Diet also plays an important role. You may incorporate low cholestrol food intake and moderate physical activity if that is a possibility.

Sending prayers your way.

🙏

[Tommyj2 in reply to Summm]

I'm a little confused.... do YOU have prostate cancer or was it your father??

[Summm in reply to Tommyj2]

My dad, but i have been all along with him during his treatment for every big and small decision.....