Androgenic Effects on Ventricular Repolarization

The study explored the link between androgen deprivation therapy (ADT) and the risk of acquired long-QT syndrome (aLQTS), torsades de pointes (TdP), and sudden death. Analyzing data from VigiBase, which contained 6,560,565 individual case safety reports, researchers found 184 cases of aLQTS and/or TdP and 99 cases of sudden death associated with ADT. Seven out of ten ADT drugs showed a significant association with these conditions. Enzalutamide, an ADT drug, was linked to a higher percentage of deaths (17%) compared to other ADTs (8.1%). In vitro studies on cardiomyocytes from induced pluripotent stem cells indicated that enzalutamide disrupted cardiac electrophysiology, an effect that could be reversed by dihydrotestosterone. The study concluded that ADTs, particularly enzalutamide, pose a risk of QT prolongation and TdP in men.