Multi-group advisory: ADT can increase cardiac risk factors

Androgen deprivation therapy (ADT) can worsen heart risk factors and may increase the risk of heart attack and/or cardiac death, although the relationship between ADT and heart attack or cardiac death has not been definitively established, according to a science advisory from a multi-organization group.

The advisory, produced by a writing group of experts from the American Heart Association, American Cancer Society, AUA, and American Society for Radiation Oncology, is an evaluation of published research about the relationship between ADT and cardiovascular events and risk factors in patients with prostate cancer.

Considerable data show that ADT can increase fat mass, increase low-density lipoprotein cholesterol, and cause blood sugar abnormalities, according to the group.

"Based on current data, it was appropriate to conclude that there may be a relationship between ADT therapy in patients with prostate cancer and future cardiovascular risk," said Glenn N. Levine, MD, a professor of medicine at Baylor College of Medicine in Houston, who served as chair of the group.

While some studies have found an association between ADT and increased cardiovascular risk, other studies have not detected the association, according to the advisory. The writing group called for future studies to prospectively analyze heart risks related to ADT whenever possible.

An increased risk with ADT was noted in 1% to 6% of the study populations. Thus, "while there may be some increased heart risk, the decision about whether to initiate ADT should be based on weighing the benefits of therapy with this potential modest risk," Dr. Levine said.

The advisory was published online in CA (Feb. 2, 2010) and Circulation (Feb. 1, 2010).

Look for more information on the advisory and urologists’ reaction in the March 2010 issue of Urology Times.