In patients with prostate cancer and high cardiovascular risk at baseline, an association was found between prolonged androgen deprivation therapy (ADT) and reduced cardiorespiratory fitness and increased risk of cardiovascular death, according to a single-center retrospective cohort study published Nov. 17 in JACC: CardioOncology.

With the increasing use of ADT regimens of increased intensity and longer duration in high-risk prostate cancer patients, Jingyi Gong, MD, et al., sought to examine the impact of ADT exposure and the influence of short-term (≤ six months) and prolonged (> six months) duration on cardiorespiratory fitness and cardiovascular mortality.

The study cohort consisted of 616 patients who had an exercise treadmill test (ETT) for clinical indications between March 7, 2002, and August 18, 2015. The median time from prostate cancer diagnosis to ETT was 4.8 years. Cardiorespiratory fitness was calculated from peak treadmill speed and grade achieved during ETT.

Nearly a quarter of the patients (n=150) had received ADT; 99 patients had long-term exposure and 51 short-term exposure. The majority of study patients (n=504; 81.8%) had two or more cardiovascular risk factors; of the patients with prolonged exposure to ADT, 92.2% had two or more cardiovascular risk factors.

The results showed that prolonged ADT exposure was associated with reduced cardiorespiratory fitness (odds ratio [OR], 2.71; 95% confidence interval [CI], 1.31-5.61; p=0.007) and increased cardiovascular mortality (hazard ratio [HR], 3.87; 95% CI, 1.16-12.96; p=0.028) in adjusted analyses.

With short-term ADT exposure, the association with reduced cardiorespiratory fitness was of borderline significance (OR, 1.71; 95% CI, 1.00-2.94; p=0.052), and no association was found for cardiovascular mortality (HR, 1.60; 95% CI, 0.51-5.01; p=0.420) in adjusted Cox regression models.

"While prolonged ADT certainly plays a role in the treatment of prostate cancer, these findings emphasize the need to consider cardiovascular surveillance/risk modification during and after ADT exposure," said study author John D. Groarke, MBBCh, MSc, MPH.

In an accompanying editorial comment, Vivek K. Narayan, MD, MSCE and Alicia K. Morgans, MD, MPH, write that this study adds value to our existing clinical knowledge base, but caution that further attention to the cardiovascular complications of varying ADT exposure durations is critical as oncologic treatment strategies evolve.

"By improving our understanding of the patient- and treatment-related factors contributing to ADT-related cardiac toxicity, oncology and cardiology providers can work collaboratively to optimally employ therapy modifications and cardiovascular risk mitigation strategies," they conclude.

Clinical Topics: Cardio-Oncology

Keywords: Odds Ratio, Androgen Antagonists, Prostatic Neoplasms, Exercise Test, Cardiotoxicity, Cardiovascular Diseases, Retrospective Studies, Risk Factors, Proportional Hazards Models, Cohort Studies, Cardiology, Knowledge Bases

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