The Effects of Induced Hypogonadism on Arterial Stiffness, Body Composition, and Metabolic Parameters in Males with Prostate Cancer
Sex hormones appear to play a pivotal role in determining cardiovascular risk. Androgen deprivation therapy for males with prostate cancer results in a hypogonadal state that may have important, but as yet undetermined, effects on the vasculature. We studied the effects of androgen deprivation thera...
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Published in | The journal of clinical endocrinology and metabolism Vol. 86; no. 9; pp. 4261 - 4267 |
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Main Authors | , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
Endocrine Society
01.09.2001
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Online Access | Get full text |
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Summary: | Sex hormones appear to play a pivotal role in determining
cardiovascular risk. Androgen deprivation therapy for males with
prostate cancer results in a hypogonadal state that may have important,
but as yet undetermined, effects on the vasculature. We studied the
effects of androgen deprivation therapy on large artery stiffness in 22
prostate cancer patients (mean age, 67 ± 8 yr) over a 6-month
period. Arterial stiffness was assessed using pulse-wave analysis, a
technique that measures peripheral arterial pressure waveforms and
generates corresponding central aortic waveforms. This allows
determination of the augmentation of central pressure resulting from
wave reflection and the augmentation index, a measure of large artery
stiffness. Body compositional changes were assessed using bioelectrical
impedance analysis. Fasting lipids, glucose, insulin, testosterone, and
estradiol were measured. After a 3-month treatment period, the
augmentation index increased from 24 ± 6% (mean ±
sd) at baseline to 29 ± 9% (P =
0.003) despite no change in peripheral blood pressure. Timing of wave
reflection was reduced from 137 ± 7 to 129 ± 10 msec
(P = 0.003). Fat mass increased from 20.2 ±
9.4 to 21.9 ± 9.6 kg (P = 0.008), whereas
lean body mass decreased from 63.2 ± 6.8 to 61.5 ± 6.0 kg
(P = 0.016). There were no changes in lipids or
glucose during treatment. Median serum insulin rose from 11.8 (range,
5.6–49.1) to 15.1 (range, 7.3–83.2) mU/liter at 1 month
(P = 0.021) and to 19.3 (range, 0–85.0 mU/liter by
3 months (P = 0.020). There was a correlation
between the changes in fat mass and insulin concentration over the
3-month period (r = 0.56; P = 0.013). In a
subgroup of patients whose treatment was discontinued after 3 months,
the augmentation index decreased from 31 ± 7% at 3 months to
29 ± 5% by 6 months, in contrast to patients receiving
continuing treatment in whom the augmentation index remained elevated
at 6 months compared with baseline (P = 0.043).
These data indicate that induced hypogonadism in males with prostate
cancer results in a rise in the augmentation of central arterial
pressure, suggesting large artery stiffening. Adverse body
compositional changes associated with rising insulin concentrations
suggest reduced insulin sensitivity. These adverse hemodynamic and
metabolic effects may increase cardiovascular risk in this patient
group. |
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ISSN: | 0021-972X 1945-7197 |
DOI: | 10.1210/jcem.86.9.7851 |