男性缺乏雄激素会增加糖尿病、心血管病的发病风险

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Androgen Deprivation Raises Men's Risk of Diabetes and Cardiovascular Disease

NEW YORK (Reuters Health) Dec 07 - Androgen deprivation therapy for prostate cancer is associated with an increased risk for new-onset diabetes and cardiovascular disease, according to a large-scale study.

"Patients and physicians considering...gonadotropin-releasing hormone (GnRH) agonist treatment for local or regional prostate cancer should factor the potential increased risks of diabetes and cardiovascular disease as they make treatment decisions," the investigators write in article published online December 7 in the Journal of the National Cancer Institute.

Previous studies have described a link between GnRH androgen deprivation therapy and theses diseases, but they were limited by a focus only on older men and by a lack of information about other medications, according to lead author Dr. Nancy L. Keating from Harvard Medical School, Boston, and colleagues.

The current report is based on data from the Veterans Healthcare Administration on 37,443 men of all ages diagnosed and treated for prostate cancer. Compared with other men, those treated with GnRH agonist therapy or orchiectomy had higher unadjusted rates for development of diabetes, coronary heart disease, myocardial infarction, sudden cardiac death, and stroke, the authors report.

After adjustment for patient and tumor characteristics, current use of a GnRH agonist (compared to no androgen deprivation) was associated with a 28% increased risk of developing diabetes, a 19% increased risk of incident coronary heart disease, a 28% increased incidence of myocardial infarction, a 35% increased risk of sudden cardiac death, and a 22% increased incidence of stroke.

The association of GnRH agonists with stroke has not been previously reported, the investigators say.

According to the article, orchiectomy was associated with a 40% increased risk of coronary heart disease and a 2.11-fold increased risk of myocardial infarction, the researchers note.

Compared with no androgen deprivation therapy, ever use of androgen deprivation therapy was associated with an increased risk of diabetes, coronary heart disease, sudden cardiac death, and stroke, but the risk for myocardial infarction was not significantly increased.

"Additional research is needed to understand the effects of GnRH agonists for clinical settings where benefits have not yet been established, to identify populations of men at highest risk of complications associated with GnRH agonists, and to investigate strategies to prevent treatment-related morbidity," the authors conclude.

In an editorial, Dr. Peter C. Albertsen from University of Connecticut Health Center, Farmington, Connecticut writes, "With the growing number of men wrestling with rising prostate-specific antigen values after treatment, we should organize appropriate trials and reflect carefully about the anticipated benefits and harm before initiating androgen deprivation therapy."

"Many older men especially those with low-grade disease may not live long enough to benefit, and we may hasten their demise from a competing medical problem," he concludes.