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Predicting Risk for Metabolic Aberrations and CV Events

Insights From: Dipti Gupta, MD, MPH, Memorial Sloan Kettering Cancer Center; Susan Slovin, MD, PhD, Memorial Sloan Kettering Cancer Center
Published: Wednesday, May 30, 2018



Transcript: 

Dipti Gupta, MD, MPH: The next thing that I want to talk about is metabolic syndrome. Metabolic syndrome is a cluster of conditions. Metabolic syndrome includes 5 things: abdominal obesity, high triglycerides, low HDL, high blood pressure, and high fasting blood sugar—all of which raise the risk of heart disease. Three out of these 5 main factors are needed for a diagnosis of metabolic syndrome.
Metabolic syndrome due to androgen deprivation therapy has some key differences that we should understand. No. 1 is that the metabolic aberrations with androgen deprivation do not include a low HDL. In fact, they increase your HDL, as we talked about. We also mentioned that despite increasing HDL, the net effect is still proatherogenic. Something to sort of keep in mind is that the metabolic syndrome that occurs with ADT is not classic metabolic syndrome—it’s sort of a mimicker of metabolic syndrome.

The prevalence of metabolic syndrome in the adult population is about 20% to 25%. Again, male hypogonadism is an independent risk factor for metabolic syndrome. And again, low testosterone can predict metabolic syndrome in men. ADT causes a high degree of alteration in metabolic parameters and increases this risk of metabolic syndrome. In some studies, one-third to about half of patients receiving ADT for more than a year developed metabolic syndrome. A recent meta-analysis, which I show here on this slide, included 9 observational studies and a cohort study. It found an even higher incidence of metabolic syndrome, up to 60% to 75%, in this population.

Susan Slovin, MD, PhD: Dr. Gupta, are there people who really are just going to be the ones who get it as opposed to others? Is there a particular phenotype that we can think of that would be more predisposed, or is it just somebody who happens to have a pre-existing high cholesterol or blood pressure who is going to do worse? Do we know before they go in?

Dipti Gupta, MD, MPH: I don’t think we have data to parse that out, but we do know from our clinical experience that patients who have uncontrolled risk factors or suboptimally controlled risk factors will obviously be at greater risk. When, going in, if your blood sugar is not very well controlled, you are at a higher risk of having a poorer control while on ADT, especially if there is a lack of awareness for both the patient and provider and they’ve not been counseled that this could be a possibility with treatment.

Susan Slovin, MD, PhD: I guess we all have to be on our toes, in terms of seeing people when they walk through the door?

Dipti Gupta, MD, MPH: Absolutely.

Transcript Edited for Clarity 
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Transcript: 

Dipti Gupta, MD, MPH: The next thing that I want to talk about is metabolic syndrome. Metabolic syndrome is a cluster of conditions. Metabolic syndrome includes 5 things: abdominal obesity, high triglycerides, low HDL, high blood pressure, and high fasting blood sugar—all of which raise the risk of heart disease. Three out of these 5 main factors are needed for a diagnosis of metabolic syndrome.
Metabolic syndrome due to androgen deprivation therapy has some key differences that we should understand. No. 1 is that the metabolic aberrations with androgen deprivation do not include a low HDL. In fact, they increase your HDL, as we talked about. We also mentioned that despite increasing HDL, the net effect is still proatherogenic. Something to sort of keep in mind is that the metabolic syndrome that occurs with ADT is not classic metabolic syndrome—it’s sort of a mimicker of metabolic syndrome.

The prevalence of metabolic syndrome in the adult population is about 20% to 25%. Again, male hypogonadism is an independent risk factor for metabolic syndrome. And again, low testosterone can predict metabolic syndrome in men. ADT causes a high degree of alteration in metabolic parameters and increases this risk of metabolic syndrome. In some studies, one-third to about half of patients receiving ADT for more than a year developed metabolic syndrome. A recent meta-analysis, which I show here on this slide, included 9 observational studies and a cohort study. It found an even higher incidence of metabolic syndrome, up to 60% to 75%, in this population.

Susan Slovin, MD, PhD: Dr. Gupta, are there people who really are just going to be the ones who get it as opposed to others? Is there a particular phenotype that we can think of that would be more predisposed, or is it just somebody who happens to have a pre-existing high cholesterol or blood pressure who is going to do worse? Do we know before they go in?

Dipti Gupta, MD, MPH: I don’t think we have data to parse that out, but we do know from our clinical experience that patients who have uncontrolled risk factors or suboptimally controlled risk factors will obviously be at greater risk. When, going in, if your blood sugar is not very well controlled, you are at a higher risk of having a poorer control while on ADT, especially if there is a lack of awareness for both the patient and provider and they’ve not been counseled that this could be a possibility with treatment.

Susan Slovin, MD, PhD: I guess we all have to be on our toes, in terms of seeing people when they walk through the door?

Dipti Gupta, MD, MPH: Absolutely.

Transcript Edited for Clarity 
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