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Experts have conflicting views on CV risk in prostate cancer therapy

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Although the results of a recent meta-analysis provide reassurance that androgen deprivation therapy (ADT) was not associated with an increased risk of cardiovascular (CV) deaths, other specialists warn against ignoring this risk.

ADT is a mainstay of prostate cancer treatment, but several studies have found that this therapy can raise the risk of fatal cardiovascular events. For the meta-analysis, reported in JAMA (2011;306[21]:2359-2366), investigators evaluated data from eight randomized trials involving 4,141 patients. They found that CV deaths in patients receiving ADT vs control were not significantly different (255 CV deaths in 2,200 ADT users, corresponding to an overall incidence of 11%; by comparison, 252 CV deaths occurred among 1,941 control patients for an overall incidence of 11.2%).

Rates of CV deaths did not differ between ADT users and controls whether trials involved long duration of ADT (at least 3 years) or short duration (6 months or less). In the long-duration studies, incidence of CV deaths was 10.5% for ADT users and 10.3% for controls. Death rates were the same (11.5%) for both groups in the short-duration trials.

Among 4,805 patients from 11 trials with overall death data, ADT was associated with lower risk of prostate cancer–specific mortality (13.5% vs 22.1%) and lower all-cause mortality (37.7% vs 44.4%) compared with controls.

An accompanying editorial (pp. 2382-2383) cautions that men with cardiac disease who have the highest risks of complications from ADT should follow the appropriate secondary preventive measures outlined by the American Heart Association (AHA): lipid-lowering therapy, antihypertensive therapy, glucose-lowering therapy, and antiplatelet therapy.

A day after the JAMA items were made public, the journal Heart released its own “viewpoint” column, in which Dr. Liam Bourke of Queen Mary University of London, United Kingdom, and colleagues referenced “mounting evidence” suggesting a link between ADT and increased risk of cardiovascular disease and, possibly, CV-related deaths.

“The concept of incorporating cardiovascular disease management into [androgen deprivation therapy] as standard has not yet percolated into clinical practice,” charged Bourke's group, calling the current status quo of no action “unsatisfactory for the patient and unlikely to be cost-effective.”

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