Cardiovascular risk small and no contraindication to ADT

[JimmyToowong]

Editorial - Absolute and relative risk of cardiovascular disease in men with prostate cancer: Results from the population-based PCBaSe Sweden

BERKELEY, CA (UroToday.com) - Androgen deprivation therapy (ADT) is reportedly associated with increased risks of diabetes, coronary artery disease, myocardial infarction (MI), sudden cardiac death, and stroke. In the online edition of the Journal of Clinical Oncology, a group of British and Swedish investigators report nonfatal and fatal absolute and relative risks of different types of cardiovascular disease (CVD) including acute MI, ischemic heart disease, heart failure and stroke. They studied a population-based cohort including 76,000 patients with CaP undergoing ADT, curative treatment, or active surveillance. Risk for CVD in the total Swedish population served as a control.

The dataset is referred to as PCBaSe Sweden, and is based upon the National Prostate Cancer Register (NPCR) of Sweden, which contains more than 96% of all CaP cases in Sweden since 1996. Standardized incidence ratios (SIR) and standardized mortality ratios (SMR) were calculated by comparing observed events in the selected cohort with the expected events in the Swedish male population. There were 76,600 men in the registry, of which 30,642 were treated with some form of endocrine therapy (ET). The SIRs for CVD ranged from 1.13 for acute MI to 1.22 for ischemic heart disease (both significant) and the SMRs for CVD ranged from 0.93 for arrhythmia to 1.17 for stroke. SMRs and SIRs for men receiving ET were increased for all CVD studied. They were also significant for men undergoing surveillance, but the risks were smaller. For men who received curative treatment, the SIRs were only increased for arrhythmia and ischemic heart disease. SIRs for CVD were increased in all treatment groups without circulatory disease at baseline, the highest for men treated with ET. Among different forms of ET, the lowest risk was among men treated with anti-androgen monotherapy. Fatal CVD risk was even more pronounced for other forms of ET compared with anti-androgen monotherapy. The increased CVD risk did not increase over time for men receiving ET. The absolute risk differences for nonfatal CVD varied from almost zero in men who underwent curative treatment, to 8 extra cases of CVD per 1,000 person-years for men receiving ET. The total absolute risk difference for dying from CVD in the ET group was 40.9/1,000 person-years and 33.7/1,000 person-years for the general population. The total absolute risk of dying from CaP in men who underwent ET was 97/1,000 person-years. The risk was higher for men with a history of circulatory disease.

This is the largest population-based evaluation of the association between ET and CVD. While it shows ET increases risks of CVD in men with CaP, the investigators conclude that the absolute risk difference compared to the general population is small and should not be a contraindication to the use of ET in men with CaP.

Van Hemelrijck M, Garmo H, Holmberg L, Ingelsson E, Bratt O, Bill-Axelson A, Lambe M, Stattin P, Adolfsson J

J Clin Oncol. 2010 Jul 20;28(21):3448-56[1]

10.1200/JCO.2010.29.1567

PMID: 20567006 Forum: Primary hormone therapy Title: Cardiovascular risk small and no contraindication to ADT

J Clin Oncol. 2010 Jul 20;28(21):3448-56

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