ASCO GU 2008 - Metabolic Syndrome In America: Implications For Treatment

Main Category: Endocrinology
Also Included In: Cardiovascular / Cardiology
Article Date: 17 Feb 2008 - 0:00 PDT

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UroToday.com - Dr. Freedland discussed the metabolic syndrome that is a combination of medical disorders that increases one's risk for cardiovascular (CV) disease. It is defined by 3 of 5 criteria; waist circumference >102cm, high triglycerides or HDL, glucose intolerance or high BP. The metabolic syndrome increases the CV risk of death in younger men by 5% over 10 years and at 12 years there is an increased overall risk of death of 20%.

ADT results in physiologic changes that are similar to the metabolic syndrome. However, ADT type metabolic syndrome differs in that the HDL cholesterol is increased in ADT as opposed to decreased as in the classic metabolic syndrome. In men on ADT, there is a much greater insulin requirement to maintain an appropriate glucose level. In the SEER analysis, ADT resulted in a 44% increased risk for diabetes, a 16% increased risk for coronary artery disease (CAD), an 11% increased risk for MI and a 16% increased risk for sudden cardiac death. The mortality risk for ADT and CAD is conflicting, but the CAD risk is increased 20%-160%. This supports the presentation by Dr. D'Amico that there is a survival decrease from ADT in men with CAD undergoing radiotherapy compared to radiotherapy alone.

The metabolic syndrome leads to higher insulin levels and insulin is a growth stimulus for CaP. In mice, a dietary reduction in insulin slowed tumor growth. On a western diet mice had 3-fold higher insulin levels, faster tumor growth and decreased survival. This suggests that a metabolic syndrome may also promote CaP progression in addition to its other affects on CAD.

Presented by Stephen J. Freedland, MD at the American Society of Clinical Oncology (ASCO) - 2008 Genitourinary Cancers Symposium - A Multidisciplinary Approach - February 14-16, 2008 San Francisco, California, USA

Reported by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS Professor & Chairman Department of Urology University of California, Davis, School of Medicine Sacramento, CA

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