Articles

Does Comorbidity Influence the Risk of Myocardial Infarction or Diabetes During Androgen-Deprivation Therapy for Prostate Cancer?

By: Nancy L. Keatinga b lowast , A. James O’Malleyb, Stephen J. Freedl, c and Matthew R. Smithd

Published online: 01 July 2013

Keywords: Prostate cancer, Myocardial infarction, Diabetes

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Abstract

Background

Androgen-deprivation therapy (ADT) for prostate cancer (PCa) may be associated with cardiovascular disease and diabetes. Some data suggest that men with certain conditions may be more susceptible to developing cardiovascular disease than others.

Objective

To assess whether the risk of myocardial infarction (MI) or diabetes during ADT is modified by specific baseline comorbidities.

Design, setting, and participants

We conducted a population-based observational study of 185 106 US men ≥66 yr of age diagnosed with local/regional PCa from 1992 to 2007. We assessed comorbidities monthly over the follow-up period.

Outcome measurements and statistical analysis

Cox proportional hazards models with time-varying variables assessing incident diabetes or MI.

Results and limitations

A total of 49.9% of the men received ADT during follow-up. Among men with no comorbidities, ADT was associated with an increase in the adjusted hazard of MI (adjusted hazard ratio [AHR]: 1.09; 95% confidence interval [CI], 1.02–1.16) and diabetes (AHR: 1.33; 95% CI, 1.27–1.39). Risks of MI and diabetes were similarly increased among men with and without specific comorbid illnesses (p>0.10 for all interactions, with one exception). Previous MI, congestive heart failure, peripheral arterial disease, stroke, hypertension, chronic obstructive pulmonary disease, and renal disease were associated with new MI and diabetes, and obesity and rheumatologic disease were also associated with diabetes. Limitations include the observational study design, reliance on administrative data to ascertain outcomes, and lack of information on risk factors such as smoking and family history.

Conclusions

Traditional risk factors for MI and diabetes were also associated with developing these conditions during ADT but did not significantly modify the risk attributable to ADT. Strategies to screen and prevent diabetes and cardiovascular disease in men with PCa should be similar to the strategies recommended for the general population.

Take Home Message

Traditional risk factors for myocardial infarction and diabetes are also associated with developing these conditions during androgen-deprivation therapy, but they do not appear to significantly modify the risk attributable to androgen-deprivation therapy. Strategies to screen for and prevent diabetes and cardiovascular disease in men with prostate cancer should be similar to strategies recommended for the general population.

Keywords: Prostate cancer, Myocardial infarction, Diabetes.

Footnotes

a Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA

b Department of Health Care Policy, Harvard Medical School, Boston, MA, USA

c Durham Veterans Affairs Medical Center, Durham, NC, USA; and Duke Prostate Center, Department of Surgery (Urology) and Pathology, Duke University, Durham, NC, USA

d Division of Hematology and Oncology, Massachusetts General Hospital (MRS), Boston, MA, USA

lowast Corresponding author. Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA. Tel. +1 617 432 3093; Fax: +1 617 432 0173.