Diabetes and Cardiovascular Disease During Androgen Deprivation Therapy for Prostate Cancer

2006 ◽  
Vol 24 (27) ◽  
pp. 4448-4456 ◽  
Author(s):  
Nancy L. Keating ◽  
A. James O'Malley ◽  
Matthew R. Smith
Keyword(s):  
Prostate Cancer ◽  
Myocardial Infarction ◽  
Cardiovascular Disease ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Sudden Cardiac Death ◽  
Androgen Deprivation Therapy ◽  
Gnrh Agonist ◽  
Cardiac Death ◽  
Androgen Deprivation

Purpose Androgen deprivation therapy with a gonadotropin-releasing hormone (GnRH) agonist is associated with increased fat mass and insulin resistance in men with prostate cancer, but the risk of obesity-related disease during treatment has not been well studied. We assessed whether androgen deprivation therapy is associated with an increased incidence of diabetes and cardiovascular disease. Patients and Methods Observational study of a population-based cohort of 73,196 fee-for-service Medicare enrollees age 66 years or older who were diagnosed with locoregional prostate cancer during 1992 to 1999 and observed through 2001. We used Cox proportional hazards models to assess whether treatment with GnRH agonists or orchiectomy was associated with diabetes, coronary heart disease, myocardial infarction, and sudden cardiac death. Results More than one third of men received a GnRH agonist during follow-up. GnRH agonist use was associated with increased risk of incident diabetes (adjusted hazard ratio [HR], 1.44; P < .001), coronary heart disease (adjusted HR, 1.16; P < .001), myocardial infarction (adjusted HR, 1.11; P = .03), and sudden cardiac death (adjusted HR, 1.16; P = .004). Men treated with orchiectomy were more likely to develop diabetes (adjusted HR, 1.34; P < .001) but not coronary heart disease, myocardial infarction, or sudden cardiac death (all P > .20). Conclusion GnRH agonist treatment for men with locoregional prostate cancer may be associated with an increased risk of incident diabetes and cardiovascular disease. The benefits of GnRH agonist treatment should be weighed against these potential risks. Additional research is needed to identify populations of men at highest risk of treatment-related complications and to develop strategies to prevent treatment-related diabetes and cardiovascular disease.

Daytime peak incidence of death due to the ischemic heart disease

2014 ◽  
Vol 2 (4) ◽  
pp. 213-227
Author(s):  
Janet H. Wilenky ◽  
Hsin Chang
Keyword(s):  
Myocardial Infarction ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Early Morning ◽  
Morning Peak ◽  
Circadian Time ◽  
Ventricular Dysrhythmias ◽  
Relationship Of

Myocardial infarction, myocardial ischemia, ventricular dysrhythmias, and sudden cardiac death occur most frequently in the morning, especially in the first few hours after awakening. Among individual patients, however, this pattern may vary widely. Up to 80% of individuals who suffer sudden cardiac death have coronary heart disease; the epidemiology of sudden cardiac death to a great extent parallels that of coronary heart disease. This review describes circadian patterns in cardiovascular disease processes and analyses the findings of recent studies by searched, from PubMed, ISI Web of Science, Google Scholar and Scopus databases in a time period between late 1970s through July 2013. The circadian pattern of numerous cardiovascular events (myocardial infarction, sudden cardiac death, stroke) reveals a peak in the early hours of the morning, which occurs in more than 20% of patients with arterial hypertension, and can be regularly detected in combined 24-h-ABPM/EKG examinations. The awareness of an increased incidence of myocardial infarction and sudden cardiac death in the early morning hours, shortly after waking, has stimulated an interest in the relationship of these events and the occurrence of both silent and symptomatic myocardial ischaemia. A number of studies have been reported that examine both the physiological triggers and the underlying causes of these events. Beta-adrenergic blockers have been shown to abolish the early morning peak of myocardial infarction and blunt the morning peak in sudden cardiac death. Newer calcium antagonists, such as amlodipine, have been demonstrated to control angina throughout a 24-hour period. Aspirin is effective in preventing morning infarction. Approaching the pathophysiology of circadian time-dependent sudden cardiac death has implication for future prevention and treatment.

Evidence for the Cardioprotective Effects of Omega-3 Fatty Acids

2002 ◽  
Vol 36 (12) ◽  
pp. 1950-1956 ◽  
Author(s):  
Douglas N Carroll ◽  
Mary T Roth
Keyword(s):  
Myocardial Infarction ◽  
Fatty Acids ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Serum Triglyceride ◽  
Biomedical Literature ◽  
Omega 3 ◽  
Increased Risk

OBJECTIVE: To review available literature regarding the cardiovascular effects of marine-derived ω-3 fatty acids and evaluate the benefit of these fatty acids in the prevention of coronary heart disease. DATA SOURCES: Biomedical literature accessed through a MEDLINE search (1966–April 2002). Search terms included fish oil, omega-3 fatty acid, sudden death, hypertriglyceridemia, myocardial infarction, and mortality. DATA SYNTHESIS: Following an early 1970's observational investigation that ω-3 fatty acids may reduce the occurrence of myocardial infarction—related deaths in Greenland Eskimos, additional trials have been conducted that support this finding. Epidemiologic and clinical trial data suggest that ω-3 fatty acids may reduce the risk of cardiovascular-related death by 29–52%. In addition, the risk of sudden cardiac death was found to be reduced by 45–81%. Possible mechanisms for these beneficial effects include antiarrhythmic properties, improved endothelial function, antiinflammatory action, and reductions in serum triglyceride concentrations. ω-3 Fatty acids are fairly well tolerated; potential adverse effects include bloating and gastrointestinal distress, “fishy taste” in the mouth, hyperglycemia, increased risk of bleeding, and a slight increase in low-density-lipoprotein cholesterol. CONCLUSIONS: ω-3 Fatty acids may be beneficial and should be considered in patients with documented coronary heart disease. They may be particularly beneficial for patients with risk factors for sudden cardiac death.

scholarly journals Impact of Androgen Deprivation Therapy on Cardiovascular Disease and Diabetes

2009 ◽  
Vol 27 (21) ◽  
pp. 3452-3458 ◽  
Author(s):  
Shabbir M.H. Alibhai ◽  
Minh Duong-Hua ◽  
Rinku Sutradhar ◽  
Neil E. Fleshner ◽  
Padraig Warde ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Sudden Cardiac Death ◽  
Androgen Deprivation Therapy ◽  
Fragility Fracture ◽  
Cardiac Death ◽  
Fragility Fractures ◽  
Androgen Deprivation ◽  
Administrative Databases ◽  
Increased Risk ◽  
Bilateral Orchiectomy

Purpose Use of androgen deprivation therapy (ADT) may be associated with an increased risk of diabetes mellitus but the risk of both acute myocardial infarction (AMI) and cardiovascular mortality remain controversial because few outcomes and conflicting findings have been reported. We sought to clarify whether ADT is associated with these outcomes in a large, representative cohort. Methods Using linked administrative databases in Ontario, Canada, men age 66 years or older with prostate cancer given continuous ADT for at least 6 months or who underwent bilateral orchiectomy (n = 19,079) were matched with men with prostate cancer who had never received ADT. Treated and untreated groups were matched 1:1 (ie, hard-matched) on age, prior cancer treatment, and year of diagnosis and propensity-matched on comorbidities, medications, cardiovascular risk factors, prior fractures, and socioeconomic variables. Primary outcomes were development of AMI, sudden cardiac death, and diabetes. Fragility fracture was also examined. Results The cohort was observed for a mean of 6.47 years. In time-to-event analyses, ADT use was associated with an increased risk of diabetes (hazard ratio [HR], 1.16; 95% CI, 1.11 to 1.21) and fragility fracture (HR, 1.65; 95% CI, 1.53 to 1.77) but not with AMI (HR, 0.91; 95% CI, 0.84 to 1.00) or sudden cardiac death (HR, 0.96; 95% CI, 0.83 to 1.10). Increasing duration of ADT was associated with an excess risk of fragility fractures and diabetes but not cardiac outcomes. Conclusion Continuous ADT use for at least 6 months in older men is associated with an increased risk of diabetes and fragility fracture but not AMI or sudden cardiac death.

Androgen Deprivation Therapy and the Risk of Coronary Heart Disease and Heart Failure in Patients with Prostate Cancer

Drug Safety ◽  
2011 ◽  
Vol 34 (11) ◽  
pp. 1061-1077 ◽  
Author(s):  
Elisa Martín-Merino ◽  
Saga Johansson ◽  
Thomas Morris ◽  
Luis A. García Rodríguez
Keyword(s):  
Prostate Cancer ◽  
Heart Failure ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Androgen Deprivation Therapy ◽  
Androgen Deprivation

scholarly journals Risk and Timing of Cardiovascular Disease After Androgen-Deprivation Therapy in Men With Prostate Cancer

2015 ◽  
Vol 33 (11) ◽  
pp. 1243-1251 ◽  
Author(s):  
Sean O'Farrell ◽  
Hans Garmo ◽  
Lars Holmberg ◽  
Jan Adolfsson ◽  
Pär Stattin ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cardiovascular Disease ◽  
Androgen Deprivation Therapy ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Androgen Deprivation ◽  
Gnrh Agonists ◽  
Cvd Risk ◽  
Comparison Cohort ◽  
Using Data

Purpose Findings on the association between risk of cardiovascular disease (CVD) and the duration and type of androgen-deprivation therapy (ADT) in men with prostate cancer (PCa) are inconsistent. Methods By using data on filled drug prescriptions in Swedish national health care registers, we investigated the risk of CVD in a cohort of 41,362 men with PCa on ADT compared with an age-matched, PCa-free comparison cohort (n = 187,785) by use of multivariable Cox proportional hazards regression models. Results From 2006 to 2012, 10,656 men were on antiandrogens (AA), 26,959 were on gonadotropin-releasing hormone (GnRH) agonists, and 3,747 underwent surgical orchiectomy. CVD risk was increased in men on GnRH agonists compared with the comparison cohort (hazard ratio [HR] of incident CVD, 1.21; 95% CI, 1.18 to 1.25; and orchiectomy: HR, 1.16; 95% CI, 1.08 to 1.25). Men with PCa on AA were at decreased risk (HR of incident CVD, 0.87; 95% CI, 0.82 to 0.91). CVD risk was highest during the first 6 months of ADT in men who experienced two or more cardiovascular events before therapy, with an HR of CVD during the first 6 months of GnRH agonist therapy of 1.91 (95% CI, 1.66 to 2.20), an HR of CVD with AA of 1.60 (95% CI, 1.24 to 2.06), and an HR of CVD with orchiectomy of 1.79 (95% CI, 1.16 to 2.76) versus the comparison cohort. Conclusion Our results support that there should be a solid indication for ADT in men with PCa so that benefit outweighs potential harm; this is of particular importance among men with a recent history of CVD.

Management of Cardiovascular Disease in Dialysis Patients

2017 ◽  
Author(s):  
John K. Roberts ◽  
John P. Middleton
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Cardiovascular Disease ◽  
Acute Myocardial Infarction ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Volume Overload ◽  
Current Evidence ◽  
Dialysis Patients ◽  
Esrd Patients

Cardiovascular disease is a common cause of death and disease in patients with end-stage renal disease (ESRD). Registry data show that 41% of deaths in ESRD patients are due to a variety of cardiovascular causes, such as acute myocardial infarction, congestive heart failure, arrhythmia/sudden cardiac death, and stroke. In the general population, each of these disease entities in isolation can be effectively managed according to evidence from large clinical trials and evidence-based guidelines. However, many of these trials did not include patients with ESRD, limiting the transferability of this evidence to the care of patients on dialysis. To complicate matters, cardiovascular events in ESRD patients are likely augmented from a unique interplay of cardiac risk due to both reduced kidney function and the necessity for artificial renal replacement therapies. In this light, the patient on dialysis is subjected to a series of unique factors: the continued presence of the metabolic perturbations of uremia and the peculiar environment of the dialysis treatment itself. Since the ESRD heart is under a considerable amount of strain due to chronic volume overload, rapid electrolyte and fluid shifts, and accelerated vascular calcification, management can be complex and outcomes multifactorial. In this review, we summarize the current evidence regarding management of acute myocardial infarction, heart failure, sudden cardiac death, and atrial fibrillation. We also address modifiable risk factors related to the dialysis procedure itself and highlight recent randomized controlled trials that included dialysis patients and measured important cardiovascular outcomes. 

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