Androgen deprivation therapy (ADT) in men with prostate cancer has been linked to an increased incidence of cardiovascular events and mortality but the underpinning mechanisms are unclear.
Endothelial dysfunction is considered a precursor for cardiovascular disease. Previous studies have reported variably on the association between ADT and endothelial function. This blinded case-control study examined endothelial function, using high-resolution ultrasound to measure flow-mediated dilatation (FMD) and glyceryl trinitrate (GTN)-mediated-dilatation in the brachial artery, in 20 men with prostate cancer (69 ± 7 years) treated by ADT (median duration 22 months, range 6-133 months) and 20 men without prostate cancer (69 ± 5 years) matched for age, physical activity, co-existent cardiovascular disease and body mass index. The magnitude of dilatation was calculated traditionally and allometrically-scaled, adjusted for baseline diameter. There were no differences between groups for resting vascular measures (mean ± SD). FMD was lower in men on ADT than controls (3.9 ± 2.1% versus 5.9 ± 3.8% for "traditional", P = 0.047; 3.7 ± 2.7% versus 6.0 ± 2.7% for allometrically-scaled, P = 0.023). Response to GTN was similar in both groups (12.2 ± 4.2% versus 14.8 ± 5.7% for "traditional", P = 0.113; 12.3 ± 4.6% versus 14.4 ± 4.6% for allometrically-scaled, P = 0.163). The magnitude of difference in mean FMD between groups was marginally altered to 2.4% (95% CI 0.3 to 4.5) after adjustment for difference in body fat mass and concomitant cardiovascular medication, with the difference in FMD remaining significant (P = 0.029). There is evidence of endothelial dysfunction in men with prostate cancer on long-term ADT. Although a causal relationship is unproven, the findings are consistent with observational reports of adverse cardiovascular outcomes associated with long-term ADT for prostate cancer.
Written by:
Gilbert SE, Tew GA, Bourke L, Winter EM, Rosario DJ. Are you the author?
Sheffield Hallam University.
Reference: Exp Physiol. 2013 May 10. Epub ahead of print.
doi: 10.1113/expphysiol.2013.073353
PubMed Abstract
PMID: 23666791
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