In Reply: Dr Edwards raises questions about the weighting of individual CAD risk factors when assessing their potential interaction with HT use in men with prostate cancer. The metabolic dysfunction resulting from HT use, including the development of insulin resistance,1 is likely to take years before clinically affecting a patient with no underlying cormorbidity or a single CAD risk factor. However, it might have more of an acute clinical effect in men with preexisting heart disease, as has been demonstrated for those with a history of a myocardial infarction or congestive heart failure.2 Therefore, finding an association by analyzing men with diabetes mellitus alone as suggested by Edwards would be unlikely in a study with a median follow-up of about 5 years and a median duration of HT use of only 4 months.
Nanda A, Chen M, D’Amico AV. Hormonal Therapy for Prostate Cancer in Men With Heart Disease—Reply. JAMA. 2010;303(1):32-33. doi:10.1001/jama.2009.1932