Does the method of androgen deprivation affect one’s risk of heart disease?

The impact of the androgen deprivation therapy on the risk of coronary heart disease in patients with non-metastatic prostate cancer: a population-based study. By Gandaglia et al. 2014

  

Concluding summary from the paper: “The administration of gonadotropin releasing hormone agonists, but not orchiectomy, is still associated with a significantly increased risk of coronary artery disease, acute myocardial infarction, and, especially, sudden cardiac death in patients with non-metastatic prostate cancer.”

 

For the full abstract, see: http://www.ncbi.nlm.nih.gov/pubmed/24612110

 

Commentary: The fact that taking luteinizing hormone-releasing hormone (LHRH) agonists have cardiovascular risks is not new.  But what is surprising about this paper is that the risk is lower with surgical castration than with chemical castration achieved with LHRH agonists. How this works is not fully understood, however the cardiovascular system has receptors for LHRH agonists. Because of the way the hypothalamic-pituitary-gonadal axis works, it is possible there would be less ligand to activate LHRH receptors in the cardiovascular system of a patient who is surgically castrated. Hopefully, there will be more research in this area.

 

One thing to notice is that many physicians and patients alike presume that surgical castration, being non reversible, is emotionally more challenging than chemical castration with LHRH drugs. However, this is area that has not been well studied. In fact, it is possible that men, who are surgically castrated, are less stressed than those receiving hormonal drug therapies simply because they do not have to go back to their doctor every 3-6 months for another drug injection. 

 

Gandaglia G, Sun M, Popa I, Schiffmann J, Abdollah F, Trinh Q-D, Saad F, Graefen M, Briganti A, Montorsi F, Karakiewicz PI. 2014. The impact of the androgen deprivation therapy on the risk of coronary heart disease in patients with non-metastatic prostate cancer: a population-based study. BJU International. 10 Mar 2014 [Epub ahead of print]