Effect of Androgen Deprivation Therapy on Cardiovascular Function in Patients with Advanced Prostate Carcinoma: a Prospective Cohort Study

Androgen deprivation therapy (ADT) is the mainstay in the management of metastatic prostate cancer (PCa). There is a concern regarding the cardiovascular effects of ADT. Despite a reported incidence of major adverse cardiac event (MACE) in up to 6%, some Asian studies show no significant change. We aimed to find the cardiovascular effects of ADT in Indian men with PCa. In this prospective cohort study, men who underwent treatment for PCa from January 2022 to January 2023 were included. The ADT arm comprised patients with locally advanced and metastatic PCa who received ADT. The control arm included localized PCa patients who underwent radical prostatectomy without any ADT treatment. The primary outcomes were the incidence of MACE, changes in the Framingham risk score (FRS), ECG, and echocardiography at 1 year. Secondary outcomes were changes in the body mass index (BMI), waist–hip ratio, lipid profile, glycaemic parameters, and ankle brachial pressure index at 1 year. Forty cases and 23 controls were analyzed. There were three (7.5%) MACE in the ADT group at 1 year with no events in the control group. The ADT group had a significant increase in the mean FRS (2.54 ± 4.45 vs 0.67 ± 2.13; p = 0.021), weight (2.83 ± 2.97 vs. 0.94 ± 1.8 kg; p = 0.004), BMI (0.9 ± 1.08 vs. 0.32 ± 0.66 kg/m²; p = 0.016), and HbA1c (0.54 ± 1.64 vs. 0.18 ± 1.08%; p = 0.023) compared to controls. A total of 7.5% of patients who received ADT developed MACE at 1 year. FRS, BMI, and HbA1c increased with ADT. Rigorous follow-up for cardiovascular and metabolic effects is essential in patients who receive ADT.