Androgen deprivation therapy and morbid obesity: Do they share cardiovascular risk through metabolic syndrome?

Androgen-deprivation therapy and metabolic syndrome in men with prostate cancer

PURPOSE/OBJECTIVES

To examine the trajectory of changes in body composition and metabolic profile in men who receive androgen-deprivation therapy (ADT) for prostate cancer.

DESIGN

Prospective longitudinal design with repeated measures.

SETTING

Urban medical center in the southwestern United States.

SAMPLE

55 men starting radiation therapy for prostate cancer.

METHODS

Changes in the parameters of metabolic syndrome were estimated with ADT (n=31) and non-ADT (n=24) groups by repeated-measures analysis of variance implemented by general linear mixed-effects models. Models included interactions between groups and follow-up time to test differences between the groups.

MAIN RESEARCH VARIABLES

Body composition and metabolic variables.

FINDINGS

The ADT group demonstrated a transient increase in waist circumference at the nine-month time point and significant changes in measures of insulin resistance were noted at the three month point. Values for diastolic and systolic blood pressure, plasma glucose, high-density lipoprotein, and triglycerides were not altered for either group. Differences in metabolic variables or measures of body composition did not differ significantly between the groups.

CONCLUSIONS

The findings demonstrate the development of insulin resistance in men receiving ADT as early as three months after starting ADT.

IMPLICATIONS FOR NURSING

Addressing survivorship concerns can lead to the development of nursing interventions designed to reduce adverse effects associated with ADT.

[Metabolic syndrome and insulin resistance in patients with prostate cancer treated with androgen deprivation hormone]

INTRODUCTION AND OBJECTIVES

Androgen suppression in prostate cancer is responsible for many side effects. Many studies, mostly retrospective, have found an association between androgen deprivation and increased cardiovascular morbidity. If the cardiovascular impact was chosen, an etiological explanation would be the occurrence of metabolic disorders, particularly insulin resistance. The objective of our work was to conduct a review of the literature assessing the impact of androgen deprivation on the onset of insulin resistance, the metabolic syndrome and changes in key markers of insulin resistance.

MATERIALS AND METHODS

A systematic review of literature from the Pubmed database search was performed using the following keywords: androgen deprivation therapy, metabolic syndrome, insulin resistance, hyperglycemia, cardiovascular diseases, cardiovascular risk, abdominal obesity.

RESULTS

Twelve studies were included, bringing into focus a 55% prevalence of metabolic syndrome in patients treated for more than 12 months, an increase in fat mass and decreased lean body mass, an increase in abdominal subcutaneous fat and in visceral adiposity. The insulin was increased in four studies (25 to 60% three months dice). The increased insulin resistance was assessed by the Homeostasis Model Assessment (HOMA) was postponed three times (12% in two prospective cohort studies of type). The increase in triglycerides (20 to 40% at 12 months) and total cholesterol (7 to 11%) was observed in five studies, and increased LDL cholesterol and HDL in three studies (9 to 22%).

CONCLUSION

All studies of this analysis appeared to converge towards the development of insulin resistance and metabolic disorders, however, no prospective cohort study of good methodological quality were identified. It would be necessary to conduct a prospective multicenter study in order to have a causal quality.