What are the cardiac effects of Goserelin (Zoladex)?

From the Guidelines

Zoladex (goserelin) is not directly associated with significant cardiac effects, but patients should be monitored for potential cardiovascular issues, particularly those with pre-existing heart disease or risk factors. While the provided evidence primarily focuses on the use of bisphosphonates in preventing cancer treatment-induced bone loss [ 1 ], it does not directly address the cardiac effects of Zoladex. However, it is known that hormone deprivation therapies, including Zoladex, can indirectly affect cardiovascular health by altering cholesterol profiles and potentially increasing the risk of cardiovascular events [ 1 ].

Some key points to consider when evaluating the cardiac effects of Zoladex include:

• Monitoring for changes in cholesterol profiles, as hormone therapy can affect lipid levels [ 1 ]
• Awareness of potential QT interval prolongation, although this is rare [ 1 ]
• Recognition that hot flashes, a common side effect of Zoladex, can sometimes be mistaken for cardiac symptoms
• The importance of regular cardiac monitoring for patients with pre-existing heart disease

It is essential to weigh the potential cardiac risks of Zoladex against its benefits in treating hormone-sensitive cancers or certain gynecological conditions. The cardiac risk profile of Zoladex is generally considered acceptable when weighed against its benefits. Patients taking Zoladex should be advised to seek immediate medical evaluation if they experience any new symptoms like chest pain, palpitations, or shortness of breath.

From the FDA Drug Label

The following additional adverse reactions were reported in greater than 1% but less than 5% of the patients treated with ZOLADEX: CARDIOVASCULAR – arrhythmia, cerebrovascular accident, hypertension, myocardial infarction, peripheral vascular disorder, chest pain;

WHOLE BODY – allergic reaction, chest pain, fever, malaise; CARDIOVASCULAR – hemorrhage, hypertension, migraine, palpitations, tachycardia;

Cardiac Effects of Zoladex:

• The FDA drug label reports cardiovascular adverse reactions, including arrhythmia, cerebrovascular accident, hypertension, myocardial infarction, and peripheral vascular disorder.
• These reactions were reported in more than 1% but less than 5% of patients treated with ZOLADEX.
• Other cardiac-related adverse reactions, such as chest pain, palpitations, and tachycardia, were also reported.
• However, the label does not provide a clear causal relationship between Zoladex and these cardiac effects.
• Key cardiac effects to consider include:
  • Arrhythmia
  • Cerebrovascular accident
  • Hypertension
  • Myocardial infarction
  • Peripheral vascular disorder
  • Chest pain
  • Palpitations
  • Tachycardia 2

From the Research

Zoladex and Cardiac Effects

• The relationship between Zoladex (goserelin) and cardiac effects is not directly addressed in the provided studies, but some studies discuss the cardiovascular risks associated with gonadotropin-releasing hormone (GnRH) agonists and antagonists.
• A study from 2021 3 found no difference in the risk of cardiovascular disease between GnRH agonists and antagonists in men with prostate cancer.
• However, another study from 2023 4 suggested that GnRH agonists, including goserelin, may be associated with a higher risk of cardiovascular adverse events compared to GnRH antagonists.
• A cost-effectiveness analysis from 2017 5 found that the GnRH antagonist degarelix may be cost-effective for patients with prostate cancer and cardiovascular risk, as it may reduce the risk of cardiovascular events.
• None of the provided studies specifically examine the cardiac effects of Zoladex in the context of breast cancer treatment, but a study from 2015 6 investigated the use of goserelin for ovarian protection during breast cancer adjuvant chemotherapy and found no direct evidence of cardiac effects.

Cardiovascular Risks Associated with GnRH Agonists

• The studies suggest that GnRH agonists may be associated with an increased risk of cardiovascular adverse events, including hypertension, myocardial infarction, and thrombosis 4.
• However, the evidence is not consistent, and more research is needed to fully understand the relationship between GnRH agonists and cardiovascular risk.
• The studies also highlight the importance of considering individual patient factors, such as history of cardiovascular disease and age, when evaluating the risks and benefits of GnRH agonist therapy 3, 4.