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November 12, 2014
When Should Patients With CV Disease Avoid
Boston—Androgen-deprivation therapy (ADT) may be an effective tool for managing prostate cancer but it also has a dangerous side effect in some patients. A new study found that use of ADT to reduce male hormones more than tripled the rate of heart-related deaths in men with congestive heart failure or prior heart attacks.
Androgen-Deprivation Therapy? The analysis was conducted by investigators from the Dana Farber/Brigham and Women’s Cancer Center and Harvard Medical School, both in Boston, and reported in BJU International. Therapy to lower male hormone levels, thereby decreasing stimulation of cancer cells, is widely used in treating prostate cancer, despite past links with cardiovascular issues and increased risks of diabetes, according to background information in the article. For the study, researchers analyzed data on 5,077 men with prostate cancer who were treated between 1997 and 2006, with 30% of them receiving ADT. After a median follow-up of 4.8 years, no association was detected between ADT and heart-related deaths in men with no cardiac risk factors or in men with diabetes, hypertension, or high cholesterol. In a subgroup of men with congestive heart failure or prior heart attack, however, cardiovascular-related deaths occurred in 7.01% of men receiving ADT vs.2.01% not on the therapy over a 5-year period. The authors point out that the data suggests that administering the therapy to 20 men with those conditions and background could result in an average of one excess cardiac death. “While androgen deprivation therapy can be a lifesaving drug for men with prostate cancer and significantly increase the cure rates when used with radiation for aggressive disease, this study also raises the possibility that a small subgroup of men who have significant heart disease could experience increased cardiac death on ADT,” said co-author Paul L. Nguyen, MD. Nguyen noted that the data in his retrospective should be weighed against larger controlled trials indicating benefit for ADT but said he still would proceed with caution. “I would still say that for men with significant heart problems, we should try to avoid ADT when it is not necessary—such as for men with low-risk disease or men receiving ADT only to shrink the prostate prior to radiation,” he said. “However, for men with high-risk disease, in whom the prostate-cancer benefits of ADT likely outweigh any potential cardiac harms, ADT should be given even if they have heart problems, but the patient should be followed closely by a cardiologist to ensure that he is being carefully watched and optimized from a cardiac perspective.” |
U.S. Pharmacist Social Connect
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