medwireNews: The use of gonadotropin-releasing hormone (GnRH) agonists is associated with an increased risk for cardiovascular disease (CVD) in men with prostate cancer and type 2 diabetes, indicates a population-based study.
“Our findings emphasize the need to monitor and control CVD risk factors, such as elevated blood glucose, abnormal lipid levels, and changes in kidney function (ie, albuminuria, estimated glomerular filtration rate, and serum creatinine levels),” in these patients, write the researchers in JAMA Network Open.
The team collated data for 2006–2016 from the Swedish National Diabetes Register and Prostate Cancer Data Base Sweden on 34,159 men with type 2 diabetes – 5714 with a diagnosis of prostate cancer and 28,445 without. A quarter (25.2%) of the men with prostate cancer used GnRH agonists, while the remaining 74.8% did not.
Men with prostate cancer taking GnRH agonists were more likely to experience a significant increase in CVD risk during 5 years of follow-up, as estimated by a risk model incorporating 12 factors, versus those without prostate cancer, with a significant hazard ratio (HR) for a 10% increase of 1.25 after adjusting for multiple confounders.
By contrast, there was no such increase in risk for individuals with prostate cancer not treated with GnRH agonists, report E Lin, from King’s College London in the UK, and colleagues.
They also analyzed data for a separate cohort comprising men with type 2 diabetes and prostate cancer who did and did not receive GnRH agonists (n=692 and 3460, respectively). In this cohort the use of GnRH agonists was again associated with a significant increase in the estimated 5-year CVD risk, at an adjusted HR for a 10% increase of 1.53.
The cumulative incidence of an increased risk score among men using GnRH agonists rose over time, a finding that “warrants further investigation,” say Lin et al.
They summarize: “Our findings expand on previous published studies showing the association between GnRH agonists and CVD risk, particularly in men with type 2 diabetes.”
A separate analysis focusing on hypertension showed that individuals with prostate cancer had a significantly reduced risk for hypertension regardless of whether they received GnRH agonists or not, at HRs of 0.70 and 0.85, respectively, relative to men without prostate cancer.
And in the second cohort, GnRH agonist use correlated with a significantly lower risk for hypertension versus no use, at an HR of 0.68.
“Our finding is in line with what could be expected from the results in preclinical study animal models that showed that castration decreases blood pressure,” but it also “warrants further study,” say the investigators.
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