Endocrinology

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Impact of androgen deprivation therapy on cardiovascular disease and diabetes
Journal of Clinical Oncology, 06/12/09

Alibhai SMH et al. - In a study to clarify whether androgen deprivation therapy (ADT) is associated with an increased risk of both acute myocardial infarction (AMI) and cardiovascular mortality, it was shown that continuous ADT use for at least 6 mos in older men is associated with increased risk of diabetes and fragility fracture but not AMI or sudden cardiac death.

• Using linked administrative databases, men age 66 yrs or older with prostate cancer (PC) given continuous ADT for at least 6 mos or who underwent bilateral orchiectomy (n = 19,079) were matched with men with PC who had never received ADT.
• Treated and untreated groups were matched 1:1 (ie, hard-matched) on age, prior cancer treatment, and yr of diagnosis and propensity-matched on comorbidities, medications, cardiovascular risk factors, prior fractures, and socioeconomic variables.
• Primary outcomes were development of AMI, sudden cardiac death, and diabetes; fragility fracture was also examined.

• The cohort was observed for a mean of 6.47 yrs.
• In time-to-event analyses, ADT use was associated with an increased risk of diabetes and fragility fracture but not with AMI or sudden cardiac death.
• Increasing duration of ADT was associated with excess risk of fragility fractures and diabetes but not cardiac outcomes.

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