Advisory warns of CV risk with androgen therapy

The use of androgen deprivation therapy for prostate cancer may increase cardiovascular risk factors and the risk for myocardial infarction and cardiac death, a scientific advisory has warned. The American Heart Association, American Cancer Society and the American Urological Association state that while it is too soon to say whether the relationship between ADT and CV disease is causal, "it is plausible" on the basis of its adverse impact on risk factors for cardiovascular disease. There have been several studies suggesting that patients taking ADT may have an increase risk of cardiovascular events including myocardial infarction and cardiovascular mortality, although other studies have not shown any such association, the authors wrote in Circulation. They therefore stressed that the advisory should not be construed as dictating clinical practice or supersede the clinical judgment of physicians, and should not be used for medico legal purposes. The writing group, which included cardiologists, urologists, and oncologists, said despite the metabolic effects of ADT and possible increase in CV risk, there was no clear indication for patients to be referred for evaluation by endocrinologists, or cardiologists prior to initiating ADT or for such patients to undergo specific cardiac testing. Instead, they recommend that the decision of whether to initiate ADT should be made by the physician treating for prostate cancer, after careful consideration of the risks and benefits of treatment. All patients on ADT should be referred to their primary-care physician for periodic follow-up evaluation for potential metabolic effects of ADT, the advisory said....