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Which hormone therapy if you have cardiovascular disease risk?

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Jim Marshall (not a doctor) said ...

Cardiovascular

If you know the term 'cardiovascular', you probably know two major things - heart attack and stroke.

A fuller list includes:

  • Abnormal heart rhythms, or arrhythmias
  • Aorta disease and Marfan syndrome
  • Congenital heart disease
  • Coronary artery disease (narrowing of the arteries)
  • Deep vein thrombosis and pulmonary embolism
  • Heart attack
  • Heart failure
  • Heart muscle disease (cardiomyopathy)
  • Heart valve disease
  • Pericardial disease
  • Peripheral vascular disease
  • Rheumatic heart disease
  • Stroke
  • Vascular disease (blood vessel disease)

Risk factors

Risk factors for cardiovascular disease that you can change:

  • Tobacco smoking
  • Not enough physical activity
  • Poor diet
  • Excessive alcohol consumption.

Risk factors your doctor can find:

  • High blood pressure
  • High blood cholesterol
  • Being overweight or obese
  • Having diabetes

People with diabetes have twice the risk of developing cardiovascular disease. The rate of stroke can be up to five times greater, and prevalence of heart attack up to ten times greater, for people with diabetes.

  • There are other special conditions your doctor may identify. For instance, for me personally, unless I work at it, I find myself with low salt levels which gives a much higher heart attack risk.

Hormone therapy (androgen deprivation therapy, ADT) 

It is a fact of life for men with prostate cancer that is know to be, or thought to be, out of the prostate, that in many treatments your doctor may recommend hormone therapy.

Simply, prostate cancer will use testosterone as a food. Hormone therapy stops your body producing testosterone.Your treatment may include just one period of hormone therapy with radiation. For many men in this group, however, the prescription is hormone therapy for the whole of your life.

Types of hormone therapy in this study

Hormone therapy mostly used with radiation, or to live long, fits into two groups:

  • Firmagon

Firmagon (degarelix) is the only member of the GnRH antagonists currently available (as of 8 December 2019). 

  • The rest

GnRH agonists include:

Zoladex (Goserelin), Lupron (leuprorelin), Eligard (leuprolide), Lucrin (leuprorelin acetate),  Suprefact/Suprecor (buserelin), Synarel (nafarelin), histrelin (Supprelin), Suprelorin/Ovuplant (deslorelin), Triptorelin (diphereline)

The choice if you are at risk of cardiovascular disease.

Simply, the authors find Firmagon (degarelix) to be a better choice if you have cardiovascular risk.

Most important is that the authors worry that specialist doctors might not be finding out from your GP if you do have cardiovascular risk before starting hormone therapy.

Problems with Firmagon (degarelix)

  • Convenience for patient. A Firmagon injection must be given every 28 days. Other ADT formulations offer, besides every 28 days, 84 days, 168 days, and even longer.
  • Convenience for doctor. Mixing the Firmagon injection takes about 15 minutes. Injecting takes several minutes, and there are special rules. Some other ADT formulations are much more straight forward.
  • Pain. Where the injection goes in. For me pain does not start until day 2.
  • Flu-like symptoms. I know this is a rare symptom because for the past 4 years I have been on Firmagon I have had the opportunity to talk to many men on this drug, and only one man has reported this - me! On days 2, 3 and sometimes longer, I feel crook! Oh well - life wasn't meant to be easy!

... end Jim

 

Int J Clin Pract. 2019 Nov 22:e13449. doi: 10.1111/ijcp.13449. [Epub ahead of print]

Cardiovascular Risk with Androgen Deprivation Therapy.

Rosenberg MT1.In LibraryGet PDF

Author information

Abstract

BACKGROUND:

From the primary care perspective, many urologists and oncologists appear to be ignoring an FDA warning to assess patients' cardiovascular (CV) risk before instituting androgen deprivation therapy (ADT) with gonadotropin-releasing hormone (GnRH) agonists. A growing body of data suggests an association between androgen deprivation therapy (ADT) and CV/cardiometabolic risk, particularly for GnRH agonists.

 

METHODOLOGY:

The author examined available evidence regarding CV side effects with GnRH agonists and antagonists to determine what urologists, medical oncologists, primary care physicians (PCPs), and patients need to know about these risks.

 

RESULTS:

Data are inconclusive and somewhat conflicting - both low testosterone and testosterone replacement have been associated with elevated CV risk, for example. But the distinction between GnRH agonists and antagonists is becoming clearer, as agonists appear to be more strongly linked with CV risk, perhaps due to the transient testosterone surge they cause upon administration. Moreover, adverse CV events associated with GnRH agonists can emerge relatively quickly, within weeks to months. Conversely, two studies show that GnRH antagonists may significantly reduce CV risk compared to GnRH agonists.

 

CONCLUSIONS:

Both GnRH agonists and antagonists carry some degree of CV risk. Although the risk appears to be lower with GnRH antagonists, urologists and oncologists should communicate with PCPs to determine patients' baseline CV risk levels before implementing ADT with either type of agent.

 

© 2019 John Wiley & Sons Ltd.

 

KEYWORDS:

GnRH antagonists; androgen deprivation therapy (ADT); cardiovascular risk; gonadotropin-hormone releasing (GnRH) agonists; myocardial infarction; prostate cancer; stroke

 

PMID: 31755635 

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Barree

Jim, a well presented article and a timely reminder of one of the possible side effects of ADT. For those at risk,like me, I think it is worthwhile monitoring my own blood pressure on a very regular basis to ensure it remains within established limits.

 

Cheers,

Barree

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