To reduce the cardiovascular and metabolic risks associated with androgen deprivation therapy (ADT) in prostate cancer (PCa) patients, clinicians should follow these simple ABCDEs, according to an article in Circulation.
ABCDEs for Prostate Cancer Survivors
- Awareness and Aspirin – Increase patient awareness of cardiovascular disease (CVD). Consider prescribing daily aspirin (81 mg).
- Blood Pressure – Manage hypertension to below 140/90 mm Hg. Try angiotensin-converting enzyme inhibitors first because of their mortality benefit to patients with diabetes and CVD.
- Cholesterol and Cigarettes – Treat hyperlipidemia with high-intensity statin therapy. Discuss quitting tobacco products.
- Diabetes, Diet, and Exercise – ADT can affect glycemic control, so monitor glucose levels and adjust diabetes therapy as needed. Metformin is preferred therapy because it improves metabolic syndrome. Encourage a healthy body weight with diet and exercise. Evidence suggests endurance training and resistance training may offset some of ADT’s effects.
ADT and Cardiovascular Risks
Studies have suggested a link between ADT and increased risk of cardiovascular events. The risks possibly differ by medication.
Gonadotropin-releasing hormone (GnRH) agonists, for example, show an association between ADT and increased low-density lipoprotein and triglyceride levels, increased fat and decreased lean body mass, increased insulin resistance, and decreased glucose tolerance. Patients’ metabolic state is similar to metabolic syndrome.
ADT has also been associated with deep vein thrombosis, pulmonary emboli, arterial thrombosis, and stroke.
Clinicians should screen for CVD risk factors in PCa patients receiving ADT and follow up every 3 months during therapy. ADT may prolong QTc, so obtain a baseline electrocardiogram. If screening reveals congestive heart failure or valvular heart disease, request an echocardiogram.
“Frankly, all men need to be cognizant of the cardiovascular risk. After all, a lot more men die of heart disease than prostate cancer every year in this country,” researcher David F. Penson, MD, professor and Chair of the Department of Urologic Surgery at Vanderbilt University Medical Center in Nashville, Tenn, stated in a press release. “It is particularly important for men on ADT since anything that affects the hormonal balance will impact cardiovascular risk.”
- Bhatia N, Santos M, Jones LW, et al. Cardiovascular Effects of Androgen Deprivation Therapy for the Treatment of Prostate Cancer: ABCDE Steps to Reduce Cardiovascular Disease in Patients With Prostate Cancer. Circulation; doi:10.1161.Circulationaha.115.012519.
- Whitney, Kathy. Prostate Cancer Survivors’ Risk of Heart Disease Studied [press release]. Vanderbilt University. February 4, 2016. Accessed at http://news.vanderbilt.edu/2016/02/prostate-cancer-survivors-risk-of-heart-disease-studied.