Mechanisms

  • Estrogen or androgen deprivation shifts metabolism toward insulin resistance, dyslipidemia, and visceral adiposity.

  • Aromatase inhibitors (AIs) remove cardioprotective estrogens; Androgen Deprivation Therapy (ADT) reduces muscle and raises LDL.
    (ASCO Cardio-Oncology 2023; NCCN 2025)

Common findings

Parameter Expected change Clinical concern
Glucose ↑ 10–20 % Diabetes onset or worsening
Lipids ↑ LDL + triglycerides Atherosclerosis
Weight/BMI +2–4 kg first year Sarcopenic obesity
BP ↑ HTN risk esp. with Abiraterone

Prevention & monitoring

  • Baseline: BMI, fasting glucose, HbA1c, lipid panel, BP.

  • Re-check every 6 months.

  • Counsel diet + aerobic + resistance exercise ≥ 150 min/wk.

  • Pharmacologic: metformin, statins, ACE-inhibitors as indicated.

  • Prefer Relugolix (Orgovyx®) in patients with high CV risk (↓ MACE ~ 50 % vs Leuprolide).

Emergency red flag
Abiraterone + no steroid = hypertensive crisis + hypokalemia → add or resume prednisone 5 mg BID.

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