J Urol: Cardiovascular incidence of GnRH agonants VS antagonists in patients with advanced prostate cancer and cardiovascular disease

!---- androgen deprivation therapy may increase the risk of cardiovascular diseaselimited data suggest that GnRH (gonadotropin-releasing hormone) antagonist may reduce the risk of cardiovascular disease compared to GnRH agonistswe conducted a Phase II randomized open-label study of men with prostate cancer and pre-existing cardiovascular disease, and randomly grouped them into a group of people who received GnRH agonisor or antagonist treatment for one yearthe main outcome of theis the endothelial function measured by the EndoPAT 2000 device (Itamar Medical, Caesarea, Israel)secondary outcome is a new cardiovascular eventtrack the development of cardiovascular disease in patients, defined as death, myocardial infarction, cerebrovascular events, transdermal angioplasty placed by coronary artery stents, or hospitalization for heart eventsresults, a total of 80 patients participated in the study, including 41 who received GnRH antagonists and 39 patients received agonistsbaseline characteristics are similar for each group of patientsdid not find a difference in the primary endpoint (endothelial function) between the groups (average sD reactive hyperemia index 2.07.15 vs 1.92-0.11, p-0.42), however, during the trial, 15 patients experienced new cardiovascular events (secondary endpoints)in 9 new major cardiovascular and cerebrovascular events, including 2 deaths, 1 myocardial infarction, 2 cerebrovascular events, 4 cases of transdermal angioplasty and insertion of coronary artery stents20% of patients who were randomly given GnRH agonists had major cardiovascular events, compared with only 3% of patients taking GnRH antagonists (P-0.013)the absolute risk of major cardiovascular events was reduced to 18.1% for 12 months of use with GnRH antagonists (95% CI 4.6-31.2, p-0.032)as far as we know, this is the first prospective study to test cardiovascular outcomes in prostate cancer patients treated with androgen deprivationthere is no difference between the main endpoints of thestudy arm However, secondary endpoints showed that patients treated with GnRH agonists had significantly more major cardiovascular and cerebrovascular events than those treated with GnRH antagonists these Phase II results suggest that for prostate cancer patients who already have cardiovascular disease, choosing androgen deprivation treatment may have different effects on heart outcomes