Review of Cardiovascular Risk of Androgen Deprivation Therapy and the Influence of Race in Men with Prostate Cancer

SIMPLE SUMMARY: Prostate cancer is the second most deadly cancer in American men. The mainstay of treatment, androgen deprivation therapy, is aimed at modifying the hormonal signals involved in growth of prostate tumors. Recent research has revealed an association between these therapies and increased cardiovascular events like myocardial infarction and stroke. The goal of this review is to provide an improved framework for recognition of the cardiovascular risks of androgen deprivation therapy (ADT) and how to identify men who have an increased risk for a cardiovascular event while on ADT. Achieving this goal means physicians can more easily engage in shared decision making with patients and provide suggestions of cardiac optimization on an individual basis considering each person’s baseline risk factors. We also aim to initiate discussion surrounding the impact of racial disparities on the incidence and research of these cardiovascular complications. ABSTRACT: Androgen deprivation therapy is the cornerstone of prostate cancer therapy. Recent studies have revealed an association between androgen deprivation therapy and cardiovascular adverse effects such as myocardial infarction and stroke. This review summarizes the available research on the cardiovascular risk of men using androgen deprivation therapy. We also discuss racial disparities surrounding both prostate cancer and cardiovascular disease, emphasizing the importance of biological/molecular and socioeconomic factors in assessing baseline risk in patients beginning androgen ablation. Based on the literature, we provide recommendations for monitoring patients who are at high risk for a cardiovascular adverse event while being treated on androgen deprivation therapy. This review aims to present the current research on androgen deprivation therapy and cardiovascular toxicity with an emphasis on racial disparities and provides a framework for clinicians to decrease the cardiovascular morbidity in men that are being treated with hormone therapy.