In a Swedish population-based cohort study reported in JAMA Network Open, Lin et al found that men with type 2 diabetes receiving gonadotropin-releasing hormone (GnRH) agonists for prostate cancer were more likely to have an increased risk for developing cardiovascular disease compared with those not receiving GnRH agonists and compared with men with type 2 diabetes without prostate cancer.
Study Details
The study involved men with type 2 diabetes and men with prostate cancer identified from the Prostate Cancer Data Base Sweden and the Swedish National Diabetes Register, with longitudinal data from 2006 to 2016.
Analyses were performed in two cohorts of men with type 2 diabetes:
- One consisted of 5,714 with prostate cancer and 28,445 without prostate cancer matched 5:1 for birth year and county of residence.
- The second consisted of 692 men with prostate cancer who received a GnRH agonist and a 5:1 matched cohort of 3,460 who did not receive a GnRH agonist.
The primary outcome measure was a 10% increase in predicted 5-year cardiovascular disease risk score using a Swedish National Diabetes Register risk model.
Key Findings
Follow-up was 11 years. Men with prostate cancer receiving GnRH agonists were significantly more likely to have increased 5-year cardiovascular disease risk score compared with both men without prostate cancer (hazard ratio [HR] = 1.25, 95% confidence interval [CI] = 1.16–1.36) and men with prostate cancer not receiving GnRH agonists (HR = 1.53, 95% CI = 1.35–1.74). Overall, men with prostate cancer—irrespective of receipt of GnRH agonists—were significantly more likely to have increased risk score vs men without prostate cancer (HR = 1.07, 95% CI = 1.03–1.12).
Men receiving GnRH agonists were significantly less likely to have increased blood pressure compared with both men without prostate cancer (HR = 0.70, 95% CI = 0.61–0.80) and men with prostate cancer not receiving GnRH agonists (HR = 0.68, 95% CI = 0.56–0.82). Overall, men with prostate cancer—irrespective of receipt of GnRH agonists—were less likely to have increased blood pressure compared with men without prostate cancer (HR = 0.81, 95% CI = 0.76–0.87).
The investigators concluded, “In this population-based cohort study, there was an increased risk of cardiovascular disease in men with type 2 diabetes who received a GnRH agonist for prostate cancer. These findings highlight the need to closely control cardiovascular disease risk factors in men with type 2 diabetes treated with GnRH agonists. The association between GnRH agonist use and decreased blood pressure levels warrants further study.”
E. Lin, MSc, of the School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research (TOUR) Team, King’s College London, is the corresponding author for the JAMA Network Open article.
Disclosure: The study was supported by the Swedish Research Council, Swedish Cancer Society, and others. For full disclosures of the study authors, visit jamanetwork.com.
