Cardiovascular Effects of Androgen Deprivation Therapy for the Treatment of Prostate Cancer

ABCDE Steps to Reduce Cardiovascular Disease in Patients With Prostate Cancer

Case Presentation: A 74-year-old man with a new diagnosis of locally advanced prostate cancer is referred to the cardio-oncology clinic for optimization of his cardiovascular health after treatment with degarelix, a gonadotropin-releasing hormone (GnRH) receptor antagonist, for his prostate cancer.
Two years ago, he had a myocardial infarction resulting in placement of a drug-eluting stent in his proximal left anterior descending artery. He has had no recurrent symptoms but lives a sedentary lifestyle. An electrocardiogram showed normal sinus rhythm. His most recent echocardiogram demonstrated a structurally normal heart with normal left ventricular ejection fraction. He takes aspirin 81 mg daily. He has hypertension, with the last recorded blood pressure of 160/90 mm Hg, and he is currently treated with metoprolol 25 mg twice daily and lisinopril 40 mg daily. He has diabetes mellitus that is treated with glipizide 10 mg daily, and his last hemoglobin A1c level was 7.4 mg/dL. He is also treated with pravastatin 40 mg daily; his low-density lipoprotein was 120 mg/dL at his most recent clinic visit. He continues to smoke 1 pack of cigarettes daily, and his body mass index is 30 kg/m2.

Overview:  Prostate cancer is the most common noncutaneous cancer diagnosed in men in the United States and the second leading cause of cancer death.1 In 2015, there were an estimated 3 million prostate cancer survivors in the United States; this number will reach 4 million in the next decade.1 Because of the indolent, slowly progressive disease course of prostate cancer and advances in early detection and effective treatment, non–cancer-related deaths are the most common causes of mortality.2 In particular, given the prevalence of pre-existing and new cardiovascular disease (CVD), ischemic heart disease is the most common noncancer cause of death in patients with prostate cancer.2  Circulation  February 2, 2016, Volume 133, Issue 5

Nirmanmoh Bhatia, Marilia Santos, Lee W. Jones, Joshua A. Beckman, David F. Penson, Alicia K. Morgans and Javid Moslehi

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