Systemic cardiovascular stress under androgen deprivation: emergence of a high risk cardioncological phenotype in primary care prostate cancer patients

Introduction

Cardiovascular disease is one of the leading causes of morbidity and mortality in patients with prostate cancer. This is driven by the high prevalence of cardiovascular risk factors (CVRF) in this population and the potential for androgen deprivation therapy (ADT) to exacerbate cardio-metabolic risk.

Aim

The aim of this study was to characterise the development of new and worsening CVRF in patients with an established diagnosis of prostate cancer treated with ADT in a primary prevention setting.

Methods

This was a multicentric cohort study. Data were collected from four primary care centres, with data-sharing agreements, in place prior to extraction. Patients were included if they had a biopsy-confirmed diagnosis of prostate cancer and had received ADT. Baseline patient characteristics, including demographics, CVRF, cardiovascular disease history, cancer characteristics and cancer treatment prior to ADT initiation, were collected and analysed.

The primary endpoint was the composite of new or worsening hypertension, diabetes, dyslipidaemia, and/or obesity during or after ADT. The secondary endpoint of Major Adverse Cardiovascular Events (MACE) included a composite of acute vascular events, revascularisation, heart failure and cardiovascular death.

Results

A total of 116 patients were included. The median age at ADT initiation was 74 years (IQR: 70–79). At baseline, hypertension was present in 47.4% of patients, dyslipidaemia in 12.9%, and diabetes mellitus in 19%. Seventeen patients (14.7%) had a history of coronary artery disease, 19 (16.3%) had atrial fibrillation, 3 (2.6%) had structural heart disease, and 2 had a left ventricular ejection fraction <50% prior to ADT initiation (Table 1). Cancer-related characteristics are summarised in Table 2.

Following ADT commencement, 48 patients (41.4%) developed new or worsening CVRF. Patients reaching the primary endpoint had a higher baseline prevalence of dyslipidaemia (29% vs 9%), hypertension (60% vs 39%), and erectile dysfunction (36% vs 20%). MACE occurred in 10 patients. At final follow-up, 10 patients had died, of whom two deaths were due to cardiovascular causes.

Conclusions

In this real-world, primary care cohort, a high burden of baseline CVRF was observed in patients with prostate cancer commencing ADT. Over almost half (46.5%) developed new or worsening CVRF following ADT initiation and/or experienced MACE, with those reaching the primary endpoint demonstrating a higher CV risk profile at baseline. These findings underscore the importance of systematic cardiovascular risk assessment prior to ADT and the need for more formalised collaboration between oncology, cardiology, and primary care to reduce cardiovascular morbidity and mortality globally in the prostate cancer population.Table 1– Demographic characteristics  Table 2– Cancer related characteristics