Androgen deprivation therapy (ADT) when used in the treatment of prostate carcinoma produces a severe state of hypogonadism. Several but not all epidemiological studies have reported that there is an increased incidence of cardiovascular disease (CVD) including myocardial infarction, life threatening arrhythmias, diabetes and sudden cardiac death (1). Studies have also shown that ADT causes adverse effects many within three months on several key cardiovascular risk factors. These include rises in fasting insulin associated with insulin resistance, HbA1c, total and LDL-cholesterol and triglycerides. There is an increase in subcutaneous fat but no clear change in visceral adiposity and a reduction in lean body mass. Furthermore there is evidence of endothelial dysfunction and increased vascular stiffness. In particular men with previous diabetes demonstrate a deterioration of their glycaemic control. Those on insulin therapy can require up to a doubling of their dose to restore adequate glycaemic control. These findings support the increasing knowledge of the association of testosterone deficiency with cardiovascular disease, metabolic syndrome, type 2 diabetes and mortality (2). A science advisory statement from the American Heart Association, American Cancer Society and the American Urological Association has recommended that all patients receiving ADT should have periodic follow-up assessment of cardiovascular risk factors and those with co-existing CVD have their secondary prevention therapy optimised (1). This should include surveillance for new onset of diabetes and symptoms of cardiovascular disease such as angina. Men with type 2 diabetes should be carefully monitored in respect to their diabetes control as well as the cardiovascular risk assessments. Currently there is no indication for specific cardiological investigations or interventions. Appropriate cardiovascular risk management may improve overall survival from prostate carcinoma. 1. Levine GN et al. Circulation 2010;121:83340. 2. Jones TH Trends Endocrinol Metab 2010;21:106673.
Declaration of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.
Funding: No specific grant from any funding agency in the public, commercial or not-for-profit sector.