Arterial vascular events may strike men on hormone therapy for prostate cancer

Men receiving hormone therapy for prostate cancer usually report arterial vascular events, according to a retrospective analysis of a pharmacovigilance database. Moreover, use of gonadotropin releasing hormone (GnRH) antagonists results in fewer overall cardiovascular (CV) and arterial vascular events compared with GnRH agonists.

The US Food and Drug Administration Adverse Event Reporting System was looked into for CV adverse event reports in men with prostate cancer on GnRH agonists, GnRH antagonists, androgen receptor antagonists, and/or androgen synthesis inhibitors from January 2000 to April 2020.

CV adverse events comprised 6,231 reports (12.6 percent) on hormone monotherapy and 1,793 reports (26.1 percent) on combination therapy. The most reported CV event was arterial vascular events, followed by arrhythmias, heart failure, and venous thromboembolism.

GnRH antagonists correlated with fewer CV adverse event reports as monotherapy (adjusted reporting odds ratio [ROR], 0.70, 95 percent confidence interval [CI], 0.59–0.84; p<0.001) and as combination therapy (ROR, 0.47, 95 percent CI, 0.34–0.67; p<0.0001), which was driven by reductions in arterial vascular events, than GnRH agonists.

Furthermore, second-generation androgen receptor antagonists and abiraterone correlated with more reports of hypertension requiring hospitalization (ROR, 1.21, 95 percent CI, 1.03–1.41; p=0.02 and ROR, 1.19, 95 percent CI, 1.01–1.40; p=0.03, respectively) and more heart failure events when used in combination with GnRH antagonists (ROR, 2.79, 95 percent CI, 1.30–6.01; p=0.009 and ROR, 2.57, 95 percent CI, 1.12–5.86; p=0.03).

“Additional study is needed to identify optimal strategies to reduce CV morbidity among men with prostate cancer receiving hormone therapy,” the investigators said.