Cardiovascular effects of hormone therapy in prostate and breast cancer: a contemporary review

Hormone therapy remains a central component in the treatment of prostate and breast cancers, yet mounting evidence highlights its potential to adversely affect cardiovascular health. This state-of-the-art review explores the cardiovascular implications of commonly used hormone therapies, including androgen deprivation therapy (ADT) in prostate cancer and estrogen-targeting therapies in breast cancer. We examine the underlying mechanisms of cardiotoxicity, summarize key findings from randomized controlled trials and observational studies, and discuss how different therapeutic classes, such as gonadotropin-releasing hormone (GnRH) agonists and antagonists, CYP17A1 inhibitors, androgen receptor pathway inhibitors, selective estrogen receptor modulators, and aromatase inhibitors, vary in their cardiovascular risk profiles. ADT has been linked to coronary artery disease, heart failure, and metabolic disturbances, with emerging evidence suggesting that GnRH antagonists may offer a more favorable cardiovascular profile compared to GnRH agonists. In breast cancer, tamoxifen appears to have neutral or even protective effects on the cardiovascular system, whereas aromatase inhibitors may increase the risk of myocardial infarction (MI) and heart failure, although findings remain inconsistent across studies. Current guidelines recommend careful cardiovascular risk stratification and ongoing monitoring in patients receiving long-term hormone therapy. Future research should aim to clarify the mechanisms underlying specific cardiotoxicities, evaluate the impact of treatment duration, and develop tailored cardio-oncology management strategies to optimize long-term outcomes.