Medical vs. surgical forms of endocrine therapy and risk for stroke, myocardial infarction

In recent years it has become increasingly evident that medical forms of endocrine therapy (i.e.,  androgen-deprivation therapy  or ADT) continue to be associated with a significant level of risk for cardiovascular diseases, including myocardial infarction (MI) and stroke. However, data on the risk level are inconsistent, and such increased risk has not been demonstrated in most prospective clinical trials (but then the men at greatest risk for such cardiovascular side effects may not have been eligible to participate in those trials).

Jespersen et al. have recently used data from the national Danish Cancer Registry to investigate the association between ADT and risk for myocardial infarction and stroke. The advantage of this national registry is that now includes follow-up data on all patients diagnosed with incident prostate cancer in Denmark over many. In this study, Jespersen et al. looked at the available data on all men initially diagnosed between January 1, 2001 and December 31, 2010.

Here are the core data identified in this analysis:

  • The database included 31,571 prostate cancer patients.
    • 9,204/31,571 patients (29 percent) received a medical form of endocrine therapy.
    • 2,060/31,571 patients (7%) were given a bilateral orchiectomy (i.e., surgical castration).
  • Compared to men who never received ADT, patients treated with medical endocrine therapy had
    • An increased risk for myocardial infarction (adjusted hazard ratio [aHR] = 1.31)
    • An increased risk for stroke (aHR= 1.19).
  • Compared to men who never receieved ADT, patients treated with a bilateral orchiectomy had
    • No increased risk for myocardial infarction (aHR = 0.90)
    • No increased risk for stroke (aHR = 1.11).

The authors state the following simple conclusion that, in this study, “we found that endocrine hormonal therapy was associated with increased risk for [myocardial infarction] and stroke. In contrast, we did not find this association after orchiectomy.” However, they are also careful to note that, “One limitation of the study is that information on prognostic lifestyle factors was not included and might have further informed our estimates.”

2 Responses

  1. It would appear that we are only talking about LHRH agonists/antagonists that lower testosterone levels. The FDA has directed that these medications carry the warning to not be administered to patients with heart and/or diabetic issues as well as those susceptible to stroke. Yet, according to this study, and in view of the fact that orchiectomies also lower testosterone levels, it would appear that something in the medications is responsible for these issues since men who had orchiectomies were not found to experience these issues. What is bothersome to me is that the patient never sees the container with the agonist/antagonist product that supposedly carries the foregoing warning, and if the prescribing/administering physician ignores the warning and fails to determine whether or not the patient is experiencing any of these health issues, woe be to the patient with the identified health issues.

  2. Medical therapy can be dangerous sometimes. We cure one thing and damage another one. Thank you for sharing this research. I hope that its results will improve our medical service.

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