Androgen deprivation therapy with agonists of GnRH: cardiovascular adverse events and comorbidity considerations in patients with prostate cancer

Abstract Study objective To assess cardiovascular adverse events and comorbidity considerations in patients with local prostate cancer (pT3N0M0) who were treated with agonists of gonadotropin-releasing hormone (aGnRH). Study design Follow-up study. Materials and methods 102 patients were enrolled to the study, 99 subjects were followed up till the study completion. The mean age was 69±8,64 years old. The study of body mass index (BMI), waist circumference (WC), fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), low-density lipoprotein-cholesterol (LDL-C), triglyceride (TG), was performed at baseline, after 3, 6 and 12 months ADT. Achievement of low threshold values of testosterone was accompanied by an increase in the levels of BMI, WC, FPG, HbA1c, LDL-C, TG over 12 months of ADT regardless of baseline age, with a maximum increase during the first 3 months of treatment, and progressively after 6 months and 12 months. FPG (mmol/l) basic, 3, 6 and 12 months, respectively 5,18±0,91; 5,67±0,93; 5,77±0,96; 5,90±1,12 (for all differences p≤0.001); HbA1c (%) 5,36±0,66; 5,66±0,83; 5,77±0,82; 5,89±0,83 (for all differences p≤0.001). WC (cm): 91.5, 95.4 (+4.2%), 96.1 (+5.0%), 96.4 (+5.4%) (for all differences p≤0.017); BMI (kg/m2): 27.4, 28.2 (+2.9%), 28.4 (+3.6%), 28.4 (+3.6%) (p≤0.004 for all differences, save for differences between values in 6 and 12 months – p=0.995); LDL-C (mmol/l): 3.04 – 3.29 (+8.2%) – 3.47 (+14.1%) – 3.61 (+18.7%) (for all differences p≤0.001), TG (mmol/l): 1.7 – 1.9 (+11.8%) – 2.0 (+17.6%) – 2.1 (+23.5%) (p≤0.004). The proportion of patients with prediabetes, type 2 diabetes, according to ADA criteria, is increasing from 15% to 66% and from 4% to 13% respectively, with arterial hypertension – from 57% to 65%, with coronary artery disease – from 22% to 31% patients in the study 12 months after the start of therapy. Conclusion Long-term androgen deprivation therapy with GnRH agonists leads to an early, progressive, clinically significant deterioration of metabolism. According to the results of monitoring comorbid conditions in dynamics, a rise in the incidence of concomitant diseases was revealed during the year of therapy. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Pirogov Russian National Research Medical University