Cardiovascular Disease & ADT.

[pjoshea13]

New U.S./Northern Ireland study using data from Scotland, below [1].

"The cohort contained 20,216 prostate cancer patients, followed for 73,570 person-years, during which there were 3,853 cardiovascular events. ADT was associated with a 30% increase in cardiovascular events ..."

"This reflected increases in cardiovascular events associated with GnRH agonists (adjusted HR=1.3 ...), degarelix (adjusted HR=1.5 ...), but not bicalutamide monotherapy (adjusted HR=1.0 ...)."

-Patrick

[1] ncbi.nlm.nih.gov/pubmed/316...

Epidemiology. 2019 Oct 21. doi: 10.1097/EDE.0000000000001132. [Epub ahead of print]

The risk of cardiovascular disease in prostate cancer patients receiving androgen deprivation therapies.

Cardwell CR1, O'Sullivan JM2,3, Jain S2,3, Harbinson MT4, Cook MB5, Hicks BM1, Mc Menamin ÚC1.

Author information

1

Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, UK.

2

Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, Northern Ireland, UK.

3

Radiotherapy Department, Cancer Centre, Belfast City Hospital, Belfast, Northern Ireland, UK.

4

Centre for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland, UK.

5

Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA.

Abstract

BACKGROUND:

Androgen deprivation therapy (ADT), with a proven role in prostate cancer management, has been associated with various cardiovascular diseases. However, few studies have investigated these associations by type of ADT, particularly for newer ADTs such as the gonadotropin-releasing hormone (GnRH) antagonist degarelix. We investigated the risk of cardiovascular disease by type of ADT in a real-world setting.

METHODS:

We identified men newly diagnosed with prostate cancer, from 2009 to 2015, from the Scottish Cancer Registry and ADTs from the nationwide Prescribing Information System. Cardiovascular events were based upon hospitalization (from hospital records) or death from cardiovascular disease (from death records). We used Cox regression to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for cardiovascular events with time-varying ADT exposure, comparing ADT users with untreated patients, after adjusting for potential confounders, including prior cardiovascular disease.

RESULTS:

The cohort contained 20,216 prostate cancer patients, followed for 73,570 person-years, during which there were 3,853 cardiovascular events. ADT was associated with a 30% increase in cardiovascular events (adjusted HR=1.3 95% CI 1.2, 1.4). This reflected increases in cardiovascular events associated with GnRH agonists (adjusted HR=1.3 95% CI 1.2, 1.4), degarelix (adjusted HR=1.5 95% CI 1.2, 1.9), but not bicalutamide monotherapy (adjusted HR=1.0 95% CI 0.82, 1.3).

CONCLUSIONS:

There were increased risks of cardiovascular disease with use of GnRH agonists and degarelix, but not with bicalutamide monotherapy. This is the first study to observe increased cardiovascular risks with degarelix, but the cause of this association is unclear and merits further investigation.

PMID: 31651660 DOI: 10.1097/EDE.0000000000001132

[Hidden]

Adt shrinks veins and compromises the heart . For sure . How do I know ? Used to have big prominent veins ,easily tapped. . Now it’s like a search for lost gold to get a good vein.... I’m still here .almost 5 years on adt . Thanks Patrick .

[Craigslife]

Just to confirm findings from personal experience. My husband (73) was diagnosed with prostate cancer in Sept of 2004. He was on Lupron and casodex for 4 years starting in 2007. Just started Lupron again earlier this year because his psa was climbing and he had exhausted most other treatments. He has 7 compression fractures on his spine and was just diagnosed with congestive heart failure. His psa did go down immediately after his first Lupron injection this year. I don’t usually post because I haven’t been very upbeat in a while, but thought some might be interested in actual experience. Of course, I am not unaware or ungrateful for the over 15 years of memories and positive life experiences we have had since his diagnosis.

Susan

[pjoshea13 in reply to Craigslife]

Hi Susan,

My wife - another Susan - has also endured 15 years of ups & downs. A few years ago, I found myself in the role of support to a partner with cancer. I can appreciate more what it's like to be the care giver.

I believe that posting - engaging with the group - can be therapeutic. I look forward to more posts from you. Perhaps a post on your experience with his compression fractures (something I find very scary.)

How is his congestive heart failure being treated?

Best, -Patrick

[Craigslife in reply to pjoshea13]

Patrick,

Thank you for your kind words. I had to go back and take a look to see when the compression fractures started. In the beginning of this year he was having horrible back pain. He had an MRI in February that showed 3 compression fractures of his spine. He went to see a surgeon that did kyroplasty to two of them. He did see some relief. In May we went to Florida and he decided to go golfing with a friend. He came back and said he injured his back again. Another MRI showed an additional 4 fractures. The surgeon said he would perform more kyroplastic surgery, and my hubby declined. I believe those sites have healed, but he spends most days laying on the couch. We do have a pain specialist and he is on fetynal patches and occasional dilaudid. In the last few months he became extremely short of breath and unable to walk more than short distances. We went to the ER and the diagnosed congestive heart failure. They gave him a diuretic and potassium. When we get back home, we will go to his cardiologist and see if there is more he can do. He has AUS surgery in November to replace the first one that only lasted about a year and then cataract surgery in December. God bless him, for coming back down with me to Florida for a few weeks. He does the best he can under the circumstances.

Susan

[herb1]

So what's the option?

[pjoshea13 in reply to herb1]

Herb,

Exercise can have a significant benefit. Dr. Myers said the he could always tell which patients were exercising & which were not. He was talking about progression of the metabolic syndrome, but I expect there is a cardio benefit.

-Patrick

[j-o-h-n]

In my most humble opinion and without proof I believe that ADT = eventual heart problems....

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 10/30/2019 5:31 PM DST