GnRH Agonists for Prostate Cancer Could Increase CVD Risk in Type 2 Diabetes

Data from a new study underlines the need for heightened awareness and control of cardiovascular risk factors among men with type 2 diabetes treated with gonadotropin-releasing hormone (GnRH) agonists for prostate cancer.

An analysis of Swedish national databases, results of the study, which included more than 5700 men with prostate cancer and 28,000 without prostate cancer, suggest there was a 53% greater 5-year risk of cardiovascular disease in men with type 2 diabetes who received a GnRH agonist for prostate cancer compared with their counterparts who did not receive GnRH agonists.

“In this population-based cohort study, there was an increased risk of cardiovascular disease in men with type 2 diabetes receiving GnRH agonists for prostate cancer. Our findings highlight the need to monitor and control cardiovascular disease risk factors in men with type 2 diabetes and prostate cancer who are receiving GnRH agonists. In addition, we found a decreased risk of hypertension in men receiving GnRH agonists, which warrants further study,” wrote investigators.

With new data leading to concerns surrounding use of GnRH agonists, a team of investigators from European institutions in the UK and Sweden sought to evaluate how use may influence cardiovascular disease risk among men with type 2 diabetes. With this in mind, investigators designed a nationwide population-based cohort study using data from 2006-2016 recorded within the Prostate Cancer Data Base Sweden version 4.1 and the Swedish National Diabetes Register. With this data, investigates created 2 cohorts, 1 included men with and without prostate cancer and another including men with prostate cancer who did and did not receive GnRH agonists.

From the databases, investigators identified 28,445 men without prostate cancer and 5174 men with prostate cancer for inclusion in their analyses. Both of these cohorts had a median age of 72.0 (SD, 11.0) years. Among the 5714 patients with prostate cancer, 692 received GnRH agonists and 3460 had no exposure to GnRH agonists, with investigators noting similar baseline characteristics between these groups.

The primary outcome of interest for the study was a 10% increase in predicted 5-year cardiovascular disease risk score. The secondary outcome of interest for the study was worsening hypertension, which was defined sing the European Society of Hypertension Guidelines. Associations between GnRH agonist use and the primary and secondary outcomes were assessed using Cox proportional hazards regression models.

Upon analysis, results indicated men with prostate cancer who received GnRH agonists had a 25% greater estimated 5-year cardiovascular disease risk score compared to those without prostate cancer (HR, 1.25 [95% CI, 1.16-1.36]) and a 53% greater estimated 5-year cardiovascular disease risk score compared to those with prostate cancer but who did not receive GnRH agonists (HR, 1.53 [95% CI, 1.35-1.74]). Further analysis demonstrated those who received GnRH agonists had a 30% lower risk of hypertension compared to those without prostate cancer (HR, 0.70 [95% CI, 0.61-0.80]) and a 32% lower risk of hypertension compared to those with prostate cancer but who did not receive GnRH agonists (HR, 0.68 [95% CI, 0.56-0.82]).

“In this nationwide, population-based cohort study of CVD risk in more than 30 000 men with type 2 diabetes with 11 years follow-up, men receiving GnRH agonists had an increased predicted 5-year CVD risk score. We also found a decrease in blood pressure in men receiving GnRH agonists and in men with prostate cancer,” investigators added.

This study, “Association of Gonadotropin-Releasing Hormone Agonists for Prostate Cancer With Cardiovascular Disease Risk and Hypertension in Men With Diabetes,” was published in JAMA Network Open.