Optimisation of cardiovascular risk factors in a dedicated cardio-oncology clinic for men with prostate cancer commencing androgen deprivation therapy
H S Yap, A Abeydeera, U Pathak, J Lee, S X Tan, D Pook, W Ranasinghe, S RamkumarAbstract
Background
Patients with prostate cancer commenced on androgen deprivation therapy (ADT) have increased cardiovascular (CV) risk. Despite this, CV risk is often under-recognised and under-treated upon ADT initiation. Dedicated cardio-oncology (CO) services may facilitate systematic CV risk assessment and optimisation in this high-risk population.
Purpose
To investigate the feasibility and early outcomes of CV risk optimisation through a dedicated CO clinic in patients with prostate cancer receiving ADT.
Method
Patients with prostate cancer treated with ADT were reviewed prospectively in the dedicated CO clinics at a Victorian tertiary cardiac centre between 01/07/23–30/06/25. Data from electronic records collected on baseline CV comorbidities, cardiac investigations, medication changes, new CV diagnoses/interventions, mortality and trends in CV risk markers.
Results
16 patients with 23 reviews (mean age 75.9±9.7years, median follow up 6.1±4.7months) were included. Baseline CV comorbidities were common (94% hypertension, 63% dyslipidaemia, 63% diabetes, 56% heart failure, 50% ischaemic heart disease, 50% with smoking history). 94% patients have CV medication modifications (total 38 modifications – 34% heart failure therapies, 24% statins, 18% antiplatelets/anticoagulants). Coronary artery disease was diagnosed in 6/8 patients without a pre-existing history. 2/16 patients required revascularisation (one patient needing percutaneous coronary intervention and one patient with coronary artery bypass grafting). During follow-up, median reductions were observed in total cholesterol (11.6%), LDL-cholesterol (18.3%), systolic blood pressure (12.4%) and HbA1c (2.1%). There was one cardiac admission and one cardiac-related death during follow up.
Conclusion
CV risk is elevated in patients with prostate cancer treated with ADT. CV risk optimisation can be feasibly achieved through a dedicated CO clinic which may have benefits in reducing CV complications.