Leuprolide Drives Higher Coronary Plaque Growth Among Patients With Prostate Cancer
Key Clinical Takeaways
- Design/Population: The REVELUTION trial prospectively evaluated 90 patients with localized prostate cancer treated with radiotherapy alone or radiotherapy plus ADT randomized to leuprolide or relugolix. Coronary CT angiography was obtained at baseline and 12 months to quantify plaque progression, with TPV as the primary end point.
- Key Outcomes: Leuprolide caused significantly greater increases in total, noncalcified, calcified, and low-attenuation plaque volumes compared with relugolix or RT alone. MACE occurred more frequently with leuprolide, while relugolix showed no significant plaque progression and no cardiovascular events.
- Clinical Relevance: These findings provide mechanistic evidence that GnRH agonists may accelerate coronary atherosclerosis more than GnRH antagonists. Relugolix may represent a safer ADT option for patients with prostate cancer who are at increased cardiovascular risk.
Sagar Patel, MD, Emory University, Decantur, Georgia, discusses updated results from the REVELUTION trial which showed that androgen deprivation therapy (ADT) with leuprolide leads to significantly greater coronary plaque progression than relugolix among patients with prostate cancer.
These results were presented at the 2025 American Heart Association Resuscitation Science Symposium in Chicago, Illinois.
Source:
Patel S, Yadalam A, Van Assen M, et al. Accelerated coronary atherosclerosis following relugolix versus leuprolide androgen deprivation therapy in men with prostate cancer (REVELUTION): An open-label randomized controlled trial. Presented at the 2025 American Heart Association's Resuscitation Science Symposium. November 7-8, 2025. Chicago, Illinois. Abstract 4352126
