new study on cardiovascular risk of ADT

Very interesting study, Definitely concerns me that I was on Lupron for so long.

You have quoted one paragraph within the article. I think this following paragraph really describes what they’ve found with Orgovyx creating much less plaque than Lupron

Conclusions and Relevance In this randomized clinical trial in men with localized PCa treated with radiation plus ADT, the GnRH agonist leuprolide was associated with greater coronary plaque progression within 12 months compared with the GnRH antagonist relugolix. This change was driven by an increase in noncalcified plaque volume and may be mediating ADT-associated CV risk.

Really glad you brought this up.

Thanks @melvinw for posting this study !

Hopefully Orgovyx will now replace older ADT drugs completely when insurance gets the memo that open heart surgery is much more expensive than 6 or 8 mos of Orgovyx ! *sigh

@surftohealth88

Indeed, some pretty simple math here.

@jeffmarc

Another thing that caught my attention was that the researchers were seeing coronary plaque progression within only 12 months of ADT therapy.

I hope this study gets attention with oncologists, despite the fact that it was published in a cardiology journal. I suspect the researchers will give several talks and presentations to reach a wider audience. But hopefully sharing it here too will raise awareness. I know the lower cardiovascular risk of Orgovyx has been discussed several times in the forum, but this study really provides sound scientific evidence for that.

@melvinw
I was on Lupron for six years and when I had scans, they told me I had arterial sclerosis. I didn’t realize that Lupron not only created it but being on it so long could have make it so much worse. I’ve had some minor heart issues according to my cardiologist, Skipped beats, double beats going on for a long periods of time. Since I don’t have any Fatigue or pain it’s not something they treat. Lupron must be the culprit.

I have always had very low cholesterol, Something that supposed to help. I also exercise a lot another thing that’s supposed to help. I don’t want a heart attack to be my solution to prostate cancer.

I made the right decision moving to Orgovyx three years ago.

@surftohealth88 The funny thing is that in Canada, they priced Orgovyx exactly the same as Firmagon (about US $215/month) and comparably to Lupron on a month-by-month basis, so it shouldn't make a difference to the provincial health ministries or private insurers. The only reason to keep prescribing the older, injectable ADTs are

1. A patient with dementia who might not remember to take a daily pill.
2. A patient who (for some reason) might react badly to GnRH antagonists.
3. Lack of awareness of the availability of Orgovyx as an alternative (it became widely available here only in 2024).

@jeffmarc

I have aortic sclerosis as well and a family history of heart disease. But I have had high LDL cholesterol my entire adult life and have been on high dose atorvastatin for decades. When I was weighing whether or not to add ADT to my salvage IMRT last year, the cardiovascular issue with ADT weighed heavily. Would I just be "shifting risk from one cause of death to another”? Two docs were pretty much dismissive of my concerns. In the end, I passed on the ADT, as the risks didn’t outweigh the potential benefits in my mind. I don’t regret that decision at all. But I am also glad to know that should the day come when ADT is the next line of therapy, that Orgovyx is the clear choice compared to Lupron. Glad you made the switch too.

Interesting. I recently moved from Lupron to Orgovyx for other reasons.

I also moved from Abiraterone to Nubeqa because I thought that my high blood pressure (190+) on hormone therapy was due to the Abiraterone (my BP for six decades before & after hormone therapy was always 123/78). I had to add Losartan to the Abiraterone to lower my BP.

I have not been on Orgovyx/Nubeqa long enough to know my new BP.

I am glad to be off of Prednisone.

@jeffmarc

My cardiologist was concerned that I was taking Lupron, so he performed a series of echocardiograms which showed my heart enlarged while on Lupron but got better after being off Lupron. I had bypass open heart surgery 19 years ago so I was at high risk of heart issues.

Prior to the publication of this REVELUTION trial, Dr. William Oh gave a lecture Oct 2025 at a PCa Symposium entitled: "Cardiovascular Side Effects of New Hormone Therapies".

He explained why there has been controversy about how much better Orgovyx is: "Dr. Oh... discusses data from the HERO trial in detail, showing a lower incidence of major adverse cardiovascular events with relugolix compared with leuprolide, particularly among men with a prior history of cardiovascular disease. In contrast, he reviews results from the PRONOUNCE trial, underscoring ongoing uncertainty and controversy in this area."

Perhaps of more interest to those here is his discussion of abiraterone:

"Beyond ADT, Dr. Oh examines the cardiovascular effects of next-generation androgen receptor pathway inhibitors (ARPIs). Retrospective analyses demonstrate higher cardiovascular-related hospitalization rates with abiraterone compared with enzalutamide. Meta-analyses of metastatic hormone-sensitive prostate cancer trials suggest that older patients, particularly those over age 75, may derive less survival benefit from abiraterone, potentially due to competing cardiovascular risk."

Dr. Oh advocates for treating advanced prostate cancer as a cardiovascular risk equivalent, emphasizing aggressive risk factor modification, interdisciplinary collaboration, and individualized therapy selection to balance oncologic benefit with cardiovascular safety."
https://grandroundsinurology.com/cardiovascular-side-effects-of-new-hormone-therapies-for-prostate-cancer/