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Hormonal Therapy for Prostate Cancer in Men With Heart Disease

Hormonal Therapy for Prostate Cancer in Men With Heart Disease To the Editor: Dr Nanda and colleagues1 reported that hormonal therapy (HT) for prostate cancer was not associated with increased mortality in men with a single coronary artery disease (CAD) risk factor. However, their analysis may have underestimated the risk to patients with diabetes. Diabetes, unlike hypertension and hypercholesterolemia, is classified as a CAD risk equivalent, meaning that patients with diabetes have a risk comparable with nondiabetic patients with established CAD.2 Moreover, androgen suppression is associated with insulin resistance,3 possibly increasing the risk of both cardiac and noncardiac complications of diabetes. Because of this, patients with diabetes should be analyzed as a separate group, lest evidence of harm be diluted or obscured by benefit to lower-risk patients. In addition, diabetes and hypertension frequently coexist,4 so the risk calculated for patients with normotensive diabetes should not be considered representative of patients with diabetes in general. Back to top Article Information Financial Disclosures: None reported. References 1. Nanda A, Chen MH, Braccioforte MH, Moran BJ, D’Amico AV. Hormonal therapy use for prostate cancer and mortality in men with coronary artery disease–induced congestive heart failure or myocardial infarction. JAMA. 2009;302(8):866-87319706860PubMedGoogle ScholarCrossref 2. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002;106(25):3143-342112485966PubMedGoogle Scholar 3. Smith MR, Lee H, Nathan DM. Insulin sensitivity during combined androgen blockade for prostate cancer. J Clin Endocrinol Metab. 2006;91(4):1305-130816434464PubMedGoogle ScholarCrossref 4. Sowers JR, Epstein M, Frohlich ED. Diabetes, hypertension, and cardiovascular disease: an update. Hypertension. 2001;37(4):1053-105911304502PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA American Medical Association

Hormonal Therapy for Prostate Cancer in Men With Heart Disease

JAMA , Volume 303 (1) – Jan 6, 2010

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References (12)

Publisher
American Medical Association
Copyright
Copyright © 2010 American Medical Association. All Rights Reserved.
ISSN
0098-7484
eISSN
1538-3598
DOI
10.1001/jama.2009.1930
Publisher site
See Article on Publisher Site

Abstract

To the Editor: Dr Nanda and colleagues1 reported that hormonal therapy (HT) for prostate cancer was not associated with increased mortality in men with a single coronary artery disease (CAD) risk factor. However, their analysis may have underestimated the risk to patients with diabetes. Diabetes, unlike hypertension and hypercholesterolemia, is classified as a CAD risk equivalent, meaning that patients with diabetes have a risk comparable with nondiabetic patients with established CAD.2 Moreover, androgen suppression is associated with insulin resistance,3 possibly increasing the risk of both cardiac and noncardiac complications of diabetes. Because of this, patients with diabetes should be analyzed as a separate group, lest evidence of harm be diluted or obscured by benefit to lower-risk patients. In addition, diabetes and hypertension frequently coexist,4 so the risk calculated for patients with normotensive diabetes should not be considered representative of patients with diabetes in general. Back to top Article Information Financial Disclosures: None reported. References 1. Nanda A, Chen MH, Braccioforte MH, Moran BJ, D’Amico AV. Hormonal therapy use for prostate cancer and mortality in men with coronary artery disease–induced congestive heart failure or myocardial infarction. JAMA. 2009;302(8):866-87319706860PubMedGoogle ScholarCrossref 2. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002;106(25):3143-342112485966PubMedGoogle Scholar 3. Smith MR, Lee H, Nathan DM. Insulin sensitivity during combined androgen blockade for prostate cancer. J Clin Endocrinol Metab. 2006;91(4):1305-130816434464PubMedGoogle ScholarCrossref 4. Sowers JR, Epstein M, Frohlich ED. Diabetes, hypertension, and cardiovascular disease: an update. Hypertension. 2001;37(4):1053-105911304502PubMedGoogle ScholarCrossref

Journal

JAMAAmerican Medical Association

Published: Jan 6, 2010

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