Antiandrogenic therapy can cause coronary arterial disease

Aim: To study the change of lipid metabolism by antiandrogen therapy in patients with prostate cancer. Materials and methods: We studied with a 2.5 years follow-up the changes in plasma cholesterols (C), triglycerides (TG), lipoproteins (LP), and apolipoproteins (Apo) B-100, A-I, and A-II profiles in 24 patients of mean age 60 years with low risk prostate cancer (stage: T1cN ₀M₀, Gleason score: 2-5) during treatment with cyproterone acetate (CPA) without surgical management or radiation therapy. Results: Significant decreases of HDL-C, Apo A-I and Apo A-II and an increase of triglyceride levels in VLDL were induced by CPA. After a period of 2.5 years on CPA treatment, four patients out of twenty-four were found to be affected by coronary heart disease. Conclusions: Ischaemic coronary arteriosclerosis with an incidence rate of 16.6% as caused by prolonged CPA therapy is mediated through changes in HDL cholesterol, Apo A-I and Apo A-II profiles, other than the well-known hyperglyceridemic effect caused by estrogen.