Evidence suggests that androgen deprivation therapy (ADT) increases the risk of cardiovascular disease (CVD) for patients with prostate cancer. While both prostate cancer risk and cardiovascular risk increase with age there is also an association between ADT and CVD.1
For men in an older age cohort, those men between the ages of 70 and 79, the risk of cardiovascular disease is higher than their risk of prostate cancer (1719.7 per 100,000 versus 1152.6 per 100,000).2 As a group, as men grow older (80 plus), this rate of cardiovascular disease risk continues to increase, while their rate of prostate cancer decreases.
The most common form of hormone therapy used for prostate cancer treatment is gonadotropin-releasing hormone agonists (GnRH include leuprolide, goserelin, and triptorelin). GnRH agonists are associated with several metabolic changes in men that are also associated with cardiovascular risk factors. These include changes in body fat and distribution, high cholesterol and triglycerides, and insulin sensitivity. As well, these can potentially lead to an increased risk of diabetes and cardiovascular events.2
A recent study found that men who had a prostate cancer recurrence and also had cardiovascular disease were 50 percent more likely to regret their treatment choice than men without CVD, perhaps due to an increase in their cardiovascular health issues as they age.3
Heart healthy recommendations
The American Heart Association has a framework called Life’s Simple 7, which includes both ideal health behaviors (nonsmoking, normal body mass index, physical activity at goal levels, and a healthy diet) and ideal health factors (cholesterol less than 200 mg/dL, blood pressure less than 120 over less than 80 mm Hg, and a fasting glucose less than 100 mg/dL). Adherence to these factors promotes overall cardiovascular health and lowers the incidence of cardiovascular disease.
The American Cancer Society and American Society of Clinical Oncologist specifically recommend four of these for men with prostate cancer: get active, eat better, lose weight, and stop smoking. While these may be hard to do, each one can make an important contribution to your overall health. As emphasized in these and other guidelines, prevention of cardiovascular disease begins with discussions of how you can make some of these lifestle changes with your healthcare team.
Coordinating cardiology and oncology
As prostate cancer screening has led to earlier diagnosis and men with prostate cancer are living longer, there has been a trend to longer-term cancer survivorship. The shift in the U.S. to long-term survivorship of cancer is a welcome change. With it comes a challenge to healthcare systems and providers to better take into account the long-term health risks beyond cancer. For men with prostate cancer, cardiovascular disease is at the top of this list.
From a public health perspective, integrating cardiovascular disease prevention efforts is important to preserve the years added due to more effective prostate cancer treatments.
There is evidence that adherence to healthy behaviors and factors may reduce the risk of both cardiovascular disease and cancer. This also highlights the importance of having both cardiologists and oncologists as part of the healthcare team for men with prostate cancer and ensuring that care is collaborative.
This research also shows the importance of your healthcare team including discussion of prostate cancer and CVD comorbidity when considering prostate cancer treatment options. For newly diagnosed men who also have a cardiovascular condition, this may be a stronger rationale for considering to active surveillance as an initial treatment option.
DeSantis CE, Lin CC, Mariotto AB, et al. Cancer treatment and survivorship statistics, 2014. CA Cancer J Clin 2014;64:252-71.
Bosco C, Bosnyak Z, Malmberg A, Adolfsson J, Keating NL, Van Hemelrijck M. Quantifying observational evidence for risk of fatal and nonfatal cardiovascular disease following androgen deprivation therapy for prostate cancer: a meta-analysis. Eur Urol2015;68:386-96.
Romo ML, McCrillis AM, Brite J, Reales D, Dowd JB, Schooling CM. Pharmacologic androgen deprivation and cardiovascular disease risk factors: a systematic review. Eur J Clin Invest 2015;45:475084.