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. 2024 Sep 3;6(5):761-771.
doi: 10.1016/j.jaccao.2024.07.011. eCollection 2024 Oct.

Adiposity and Muscle Strength in Men With Prostate Cancer and Cardiovascular Outcomes

Darryl P Leong  1   2 , Vincent Fradet  3 , Tamim Niazi  4 , Joseph B Selvanayagam  5 , Robert Sabbagh  6 , Celestia S Higano  7 , Steven Agapay  1 , Sumathy Rangarajan  1 , Rajibul Mian  1 , Carlos A K Nakashima  8 , Negareh Mousavi  9 , Ian Brown  10 , Felipe H Valle  11 , Luke T Lavallée  12 , Bobby Shayegan  13 , Kelvin K H Ng  2 , Darin D Gopaul  14 , Germano D Cavalli  2 , Sonia Saavedra  15 , Jose P Lopez-Lopez  16 , Cristiano Freitas de Souza  17 , Emmanuelle Duceppe  18 , Lívia F Avezum Oliveira  19 , Avirup Guha  20 , Juan Esteban Gomez-Mesa  21 , Luis Eduardo Silva Móz  22 , Philippe D Violette  23 , Álvaro Avezum  24 , Gustavo B F Oliveira  24 , Ariel G Kann  24 , Edilson Walter  25 , Cesar O L Dusilek  26 , Nicolas Villareal Trujillo  27 , Patricia Beato  28 , Ludhmila A Hajjar  29 , Patrick P W Luke  30 , Eduardo Schlabendorff  31 , David Sarid  32 , Jehonathan Pinthus  33
Affiliations

Adiposity and Muscle Strength in Men With Prostate Cancer and Cardiovascular Outcomes

Darryl P Leong et al. JACC CardioOncol. .

Abstract

Background: There are limited data on the physical effects of androgen deprivation therapy (ADT) for prostate cancer (PC), and on the relationships of such measures of adiposity and strength to cardiovascular outcomes.

Objectives: The primary objective of this study was to evaluate the relationships of measures of adiposity and strength to cardiovascular outcomes (cardiovascular death, myocardial infarction, stroke, heart failure, arterial revascularization, peripheral arterial disease, and venous thromboembolism) in patients with PC. A secondary objective was to characterize the relationships between ADT use and 12-month changes in these physical measures.

Methods: This international, prospective cohort study included 3,967 patients with PC diagnosed in the prior 12 months or being treated with ADT for the first time. Median follow-up duration was 2.3 years.

Results: Participants' mean age was 68.5 years, and 1,731 (43.6%) were exposed to ADT. ADT was associated with a 1.6% increase in weight, a 2.2% increase in waist circumference, a 1.6% increase in hip circumference, a 0.1% increase in waist-to-hip ratio, a 27.4% reduction in handgrip strength, and a 0.1% decrease in gait speed. High waist circumference and low handgrip strength were associated with adverse cardiovascular outcomes. Adjusting for age, education, race, tobacco and alcohol use, physical activity, cardiovascular disease, glomerular filtration rate, and ADT use, waist circumference above the highest quartile (110 cm) and handgrip strength below the lowest quartile (29.5 kg) were associated with higher likelihoods of a future cardiovascular event, with respective HRs of 1.40 (95% CI: 1.03-1.90; P = 0.029) and 1.59 (95% CI: 1.14-2.22; P = 0.006).

Conclusions: ADT was associated with increased adiposity and reduced strength over 12-month follow-up. High waist circumference and low baseline strength were associated with future adverse cardiovascular outcomes.

Keywords: adiposity; androgen deprivation therapy; cardiovascular; muscle strength; obesity; prostate cancer.

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Conflict of interest statement

Research support for this study was provided by the Movember Foundation, the Canadian Cancer Society, and Tolmar Pharmaceuticals. This study was presented in part at a Late-Breaking Science Session at the Scientific Sessions of the European Society of Cardiology, Amsterdam, the Netherlands, August 28, 2023. Dr Leong has received consultancy fees or honoraria from Abbvie, Ferring, Ipsen, Janssen, Jazz Pharmaceuticals, Myovant, Novartis, Pfizer, Sanofi, Antev, AstraZeneca, Bayer, Boston Scientific, and XFacto; and has received research support from Novartis and Tolmar. Dr Higano has received consultancy fees or honoraria from AstraZeneca, Astellas, Bayer, Genetech, Eli Lilly, Merck Sharp & Dohme, Myovant, Menarini, Tolmar, Vaccitech, and Verity; is a stockholder of CTI Biopharma; and is a data and safety monitoring board member or chair in trials sponsored by AstraZeneca, Advantagene, and Exelixis. Dr Lavallée is an advisory board member for Astellas, Knight, Bayer, and AAA; and has received a grant from Tolmar unrelated to the present work. Dr Gopaul is an advisory board member for and has received honoraria from TerSera, Bayer, Ferring, Abbvie, and Knight. Dr Duceppe has received grant funding from Roche Diagnostics and Abbott Laboratories. Dr Guha is an advisory board member for Pfizer, Myovant, and Novartis; and has received research grants from the American Heart Association (847740 and 863620) and the U.S. Department of Defense PC Research Program (HT94252310158). All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Physical Measurements Stratified by ADT Use Estimates were obtained from linear mixed-effects models adjusted for age, education, ethnicity, alcohol and tobacco use, physical activity levels, cardiovascular disease, and glomerular filtration rate. An interaction P value <0.05 suggests that the change in the physical measurement differs between the androgen deprivation therapy (ADT) and no-ADT groups.
Figure 2
Figure 2
Kaplan-Meier Curves for Incident Adverse Cardiovascular Events Stratified by Quartile of Each Physical Measure Cardiovascular events included cardiovascular death, myocardial infarction, stroke, peripheral arterial disease, arterial revascularization, heart failure and venous thromboembolism. P values represent the log-rank test for equality of the curves. The y-axes represent the proportion of participants developing cardiovascular events. Q = quartile.
Central Illustration
Central Illustration
Adverse Cardiovascular Events, Adiposity, and Muscle Strength and Their Relationships With ADT Baseline waist circumference >110 cm and handgrip strength <30 kg were associated with an increased risk for adverse cardiovascular events. Androgen deprivation therapy (ADT) use was associated with accelerated increase in waist circumference and loss of handgrip strength. MACE = major adverse cardiovascular events.
See this image and copyright information in PMC

References

    1. Saylor P.J., Smith M.R. Metabolic complications of androgen deprivation therapy for prostate cancer. J Urol. 2013;189:S34–S42. - PubMed
    1. Leong D.P., Fradet V., Shayegan B., et al. Cardiovascular risk in men with prostate cancer: insights from the RADICAL PC Study. J Urol. 2020;203:1109–1116. - PubMed
    1. Weiner A.B., Li E.V., Desai A.S., Press D.J., Schaeffer E.M. Cause of death during prostate cancer survivorship: a contemporary, US population-based analysis. Cancer. 2021;127:2895–2904. - PubMed
    1. Maalouf N.M., Chhabra A., Zafereo J., et al. Androgen deprivation therapy differentially impacts bone and muscle in the short term in physically active men with prostate cancer. JBMR Plus. 2022;6 - PMC - PubMed
    1. Leong D.P., Teo K.K., Rangarajan S., et al. Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study. Lancet. 2015;386:266–273. - PubMed

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