Men receiving androgen deprivation therapy (ADT) for prostate cancer (PCa) have a higher risk of experiencing heart failure, according to new findings published in The Journal of Clinical Pharmacology.
Previous studies of Western populations have yielded inconsistent results, so Yu-Ching Chou, PhD, of the National Defense Medical Center in Taiwan, and collaborators examined the association in Asian patients. Using the Taiwan Longitudinal Health Insurance Database 2005, the investigators identified 1244 PCa patients who received ADT and 1806 who did not. Patients with orchiectomy or history of heart failure were excluded from analyses.
Over 1 year of follow up, heart failure developed in ADT users in the full cohort at a rate of 4 vs 1.89 persons per 100 per year. In analyses adjusting for age, comorbidities, income, location, and urbanization level, men who received ADT had a significant 72% higher risk for heart failure than men not using the treatment.
To further minimize bias, investigators conducted a propensity score-matched cohort study, which showed that heart failure was nearly twice as likely to develop in ADT recipients.
Duration of ADT influenced results. Compared with the no-ADT group, men receiving ADT long term (more than 6 months in a year) had a significant 2.4 times higher risk of heart failure. Short-term ADT users did not have significantly greater risk.
The findings agree with most prior studies on the subject, according to the researchers. They discussed a few possible mechanisms. For example, ADT may lead to testosterone deficiency or glucose intolerance. Alternatively, as suggested in another study, long-term ADT use may adversely alter lipid and insulin levels, known risk factors for heart failure.
Limitations of the patient database include a lack of information on body mass index, smoking, alcohol consumption, cancer stage, and genetic profile.
The authors recommend that clinicians counsel ADT patients regarding modifiable heart failure risk factors, lifestyle improvements, and relevant cardiovascular examinations.
Han Kao H, Kao LT, Hsun Li I, et al. Androgen Deprivation Therapy Use Increases the Risk of Heart Failure in Patients With Prostate Cancer: A Population-Based Cohort Study. J Clin Pharmacol. 2018;0(0):1–9