Counteracting the negative effects of ADT on the CV system?

[Scooter22]

I’m 66. I started Orgovyx in Oct. of ‘21, then completed sbrt in Nov.. My MO wants me on adt for 2 yrs.. That’s fine as I’ve tolerated the physical effects pretty well. I exercise regularly (walking ever day, weights every other day). But, my bloodwork is coming back with high triglycerides & cholesterol. I currently take no other medications. I do take supplements including fish oil & krill oil. I’m scheduled to see a cardiologist the next time I go to Duke just to discuss this situation. My RO said most of his patients die of heart attacks & not prostate cancer. I’m looking for info. that some of you guys may have gleaned from your experiences with your own drs. that could help me counteract these negative CV effects. Thanks.

[Tall_Allen]

I take statins.

[Scooter22 in reply to Tall_Allen]

I know many people do but don’t they come with their own risks?

[Tall_Allen in reply to Scooter22]

Some get myopathy (although it may be a nocebo). I use pitavastatin, which is known to have less of that side effect. I order it from India because it is cheaper. Never had any side effects.

My lipids:

LDL=79mg/dl (<100);

VLDL=10mg/dl (<30);

HDL=56mg/dl (>60);

cholesterol=144mg/dl (<200);

triglycerides=50mg/dl (<150);

[Justfor_]

I have familial hypercholesterolemia that translates to a ball park of 350 even under the strictest diet. I have been taking statins on and off since the mid 80s. After PCa diagnosis, 3.5 years ago, I am full time on Atorvastatin 20mg + Ezetimibe 10mg. Haven't noticed any SE.

[Scooter22 in reply to Justfor_]

Thanks. I’ll be interested to hear what this Duke cardiologist has to say when she sees my new bloodwork.

[Cooolone]

Prescription Omega-3 (Vascepa), Rosuvastatin and Orgovyx... In addition to Metformin. I'd have to look up my numbers, but the lipids and cholesterol got high when I was diagnosed back in 17, along with glucose as well. Got it all under control via diet, until chemo kinda whacked my system and kicked some into high gear. So I now have drugs for all because control via diet alone, is less. The Orgovyx is much more beneficial to patients in regard to CV issues over Lupron. I'm not sure the Vascepa is better than the regular drug for lipids, but I'm game to keep at it and see how well it does. I won't give up my occasional steak though (maybe once a month)... And some eggs here and there. But otherwise a healthy diet that avoids Oxalates as well due to having those kidney stones!!!

Diet as we get older is a minefield, lol...

Good luck!

[Scooter22 in reply to Cooolone]

Thanks, wasn’t aware of the prescription Omega 3. I feel I’m already taking some pretty high quality otc Omega 3 sources but I assume I can get a more regulated dose AND my Medicare prescription plan would pay for it.

[Cooolone in reply to Scooter22]

My doctor replaced Fenofibrate with the Vascepa. I think the Fenofibrate worked a little better, but I like the Omega-3 although they are horse pills! I need to dig and look at my blood work over time. Like I said though, I believe the Chemo causes havoc on our systems so I'm still giving it a little time to see.

Good Luck!

[ADTMan in reply to Cooolone]

I took fenofibrate (Tricor) and pravastatin and then Zocor for years. I also took Vascepa when it came out. My trigylcerides (23 and me said I had a genetic predisposition) were in the 350 range, sometimes over 500. I stopped taking everything as my blood sugar A1c was getting in the borderline range. As far as I am concerned unless you have familial hypercholesterolemia you shouldn't take these drugs. My decisions were informed by this: thennt.com/nnt/statins-for-... The numbers needed to treat to get a meaningful benefit are ridiculously high. My advice to anyone is to reduce carbohydrates and sugar to as little as possible and get some exercise.

[Scooter22 in reply to ADTMan]

Interesting. Thanks for info.. Was totally unaware that statins can elevate your chance of diabetes. Doesn’t sound like a good combo with adt.

[London441]

Clean diet with low carbs helps. Weights are a must on ADT of course. Increasing the exercise frequency and intensity helps too.

The problem is ADT side effects resist our efforts to counter them, CV issues included.

Statins are very effective, more than worth the risk of their side effects, which are puny by comparison.

[Murk]

I am not on any ADT or any meds so you need to research any interactions with Vitamins and/or Supplements. Having said that Omega-3 will increase your good HDL to balance out the bad. I also take 500 mg Niacin (B-3) vitamins which lowered my bad Cholestrol. I lowered my triglycerides with Chromium Nicotinate (800 mcg) supplement.

Most here poo poo vitamins / supplements but there organic verbs statins and other drugs.

[WilsonPickett]

My mothers been taking statins for 30 years, she’s 97 and still here. My dad took statins and he lived until 96. I’m taking statins, no issues after two years. I think the whole world takes statins. Some they work, and for some they don’t. Some have reactions, some don’t. There’s many different types, and the effectiveness of statins can vary widely depending on the condition being treated. My wife has high cholesterol, but she won’t take them. She has joint pain as a result, and they don’t really lower her cholesterol. So there you go…

[Scooter22]

It’ll be interesting to hear what this young Duke cardiologist has to say about all this info..

[rbiker]

For what it's worth, I am also taking Orgovyx (grade 8, T2b, 3/12 biopsy cores cancer, no apparent 'escape' from prostate). I have 2 more rad treatments left out of 20 (60 Gy total). I have been on the ADT for almost 4 months. Dealing with it reasonably well - mostly notice a lack of power on the bike. As everyone says, exercise is key to maintaining energy, etc.

First, just FYI, I've had two RO's tell me that 1 year of ADT should be sufficient, if not optimal, in my case ("diminishing returns after that"). Another RO told me 6 months of ADT - not clear what data he was using, and I ended up not using him for treatment for various reasons. I am definitely stopping after 1 year. Love to stop sooner, but....no data to support that.

Second, I am also diabetic and taking non-mealtime insulin ("Lantus" equivalent). I had to increase my dose by about 25% to keep the glucose in line. I don't normally have too-high lipids, but they have been up there so I'm on 40 mg of Atorvastatin, in addition to Metformin.

Lipids are excellent at this time. I've read that CoQ10 helps when taking statins, but haven't really done in research on that.

Anyway, best of luck to you!

[Scooter22 in reply to rbiker]

Good luck to u & thank u!

[Vynbal]

No advice here, just validation. I was on Orgovyx for 6 months, my triG's rose about 70%, but still in the "normal" range, so I was concerned but did nothing. Levels returned to my usual lower level afterwards. Good luck brother.