6000+ retrospective study. Abi increased cardio events by about 30% compared with enza. Significant for all with pre existing cardio risk. (that's most of us)
practiceupdate.com/C/123767...
"These data suggest an increased risk of stroke or MI with abiraterone use compared with enzalutamide, suggesting that enzalutamide may be indicated in patients with prostate cancer with a high cardiovascular risk."
It's misleading to title this "cardio risk." In fact, the risk of myocardial infarction was no different, about 3% in each. The risk of stroke was 3.5% for Zytiga and 2.5% for Xtandi, which was statistically significant. The authors attribute the small increase in stroke risk to the higher incidence of high blood pressure (BP) in men taking Zytiga. This is why it is important to take an adequate amount of prednisone with it to keep BP under control. This was only a retrospective data analysis and not a comparative clinical trial, which would be needed to draw practice-changing conclusions.
Retrospective data is better than no data. Gold standard clinical trials for all health issues would exceed the resources of our planet. Its an imperfect world but we need to make decisions anyway. The last sentence in quotes is a quote from the conclusion and is sufficiently clear for us to take into account in making our own decisions. Its not determinative.
I guess you didn't read the full report. They wanted to know if it made a difference on stroke OR MI. It made a difference, but only a small difference on stroke risk (because of BP) but not on MI risk. You drew an erroneous conclusion because you didn't read it carefully.
It is hard for me to understand why you would not read the full report if it is of interest to you. There is a button you can click on below the summary. Here is the full report:
esmoopen.com/article/S2059-...
It is definitely not true that retrospective data is better than no data. Sometimes retrospective data leads you to an opposite conclusion from the truth. The perfect example is Vitamin E. The retrospective data suggested it helped prostate cancer. When they did a large prospective trial (SELECT), they found that it contributed to prostate cancer. If you are going to use "Dr Google" it is important to your health that you understand levels of evidence and why some studies are practice-changing while others are just fodder for more studies. It is also important to actually read the study when it is so readily available to you.
Good point about prednisone.
How’s your cardiovascular fitness? The small differences of CV risk in these drugs is nothing.
CV risk 3% for both Zytiga and Xtandi, and a minuscule difference for stroke risk-because of the prednisone…
This tells you what you need to know! The difference strength and fitness makes is dramatic, easily more so than any other factor. Don’t bark up the wrong tree.
I have personal experience with both drugs, Xtandi and Zitiga. When lupron failed, about 5 years ago, I took Xtandi. My PSA dropped like a rock but my wife thought it had a negative impact on my cognitive abilities. However, I took it until it failed. About three years ago another oncologist recommended one Zitiga a day with food. It may have worked about 3 months. I do not recall any major side effects with either drug. However, aside from cancer i was in good shape and worked out often while on those drugs. I wish I could say that today :-). Good luck to you. I wish you the best outcome.
Xtandi monotherapy is very effective
Enzalutamide plus leuprolide reduces risk of metastasis in nonmetastatic HSPC men-from Urology Times, 29 Apr 2023
Enzalutamide approved for patients with high risk of metastasis 
Type of ADT & and cardiovascular risk.
Rosuvastatin Issue
