Frances Dockery

The Relationship Between Androgens and Arterial Stiffness in Older Men

Objectives: To assess the relationship between endogenous androgen levels and arterial stiffness in older men.

Anti-androgens increase N-terminal pro-BNP levels in men with prostate cancer.

Objective  The aim of this study was to determine the effects of anti‐androgens on left ventricular (LV) function and levels of N‐terminal proB‐type natriuretic peptide (NT‐proBNP), a sensitive cardiac risk marker, in men with prostate cancer as these are widely used drugs in this condition, and evidence suggests that endogenous androgens are cardioprotective in men.

Effect of androgen suppression compared with androgen receptor blockade on arterial stiffness in men with prostate cancer.

Endogenous testosterone and estradiol are thought to be cardio-protective in men. We wanted to determine the effects of 2 different anti-androgen therapies on arterial stiffness as one suppresses (goserelin--a gonadotrophin-releasing hormone analog) while the other increases (bicalutamide--an androgen receptor blocker) both testosterone and estradiol. We conducted a randomized trial on 43 men (mean age, 71.2 +/- 6.2 years) with localized prostate cancer. They received either goserelin or bicalutamide for 24 weeks. Carotid-femoral (C-F) and carotid-radial (C-R) pulse wave velocities (PWVs) were measured. Twenty age- and disease-matched men with prostate cancer on no active treatment were studied in a similar manner. After 12 weeks of goserelin, radial artery PWV increased significantly from baseline and a nonsignificant increase was observed in femoral PWV (change from baseline radial: +1.4 m/s, P = .002, femoral: +0.9 m/s, P = .127) Both PWV measures increased significantly with bicalutamide (change from baseline radial: +0.8, femoral: +0.9 m/s, P <or= .049). PWV increased further after 24 weeks with goserelin (change from baseline radial: +1.7, femoral: +1.3 m/s, P <or= .049 for both) but not bicalutamide (change from baseline radial: +0.4, femoral: +0.4 m/s, P not significant [NS]); however, comparison of changes between the 2 drugs were not significantly different at either 12 or 24 weeks (P >or= .967 at 12 weeks and P >or= .07 at 24 weeks). The untreated men studied in parallel showed no changes at 12 or 24 weeks in either PWV measure. Anti-androgen treatment in men might increase large artery stiffness, an adverse cardiovascular risk factor; however, the effect was not maintained with testosterone receptor blockade, in the longer term, but tended to be sustained with suppression therapy. This could relate to the different sex hormone effects of the 2 therapies.

Androgens, ageing and vascular function

We will never be perfect in achieving a diagnosis in every patient, and the challenge of geriatrics is how difficult it can be in some patients, and indeed, whether it is appropriate in others. An audit of our own ill-defined diagnoses showed that re-admission rates, at 1 month, were 10%, very similar to our better defined patients, and the great majority did not return to hospital within the next year. But that should not make us complacent. Walsh’s paper should make us all reflect upon the systems that operate for our older people, and the continuum of care from the front door to after-discharge, including the information (clinical and managerial) that goes along with it. We were trained as geriatricians and should continue to ensure that older people get the care they deserve at the time they deserve it, in the place they deserve it. MATT THOMAS Consultant Physician, Poole Hospital NHS Foundation Trust, Poole BH15 2JB, UK Tel: +44 (0)1202 448160; Fax: +44 (0)1202 442993 Email: Matt.Thomas@poole.nhs.uk