Cardiovascular Risk Factors and Prostate Cancer in U.S. Veterans
Posted: Friday, April 16, 2021
Cardiovascular disease may be underassessed and undertreated in some patients with prostate cancer. Bonnie Ky, MD, MSCE, of the University of Pennsylvania, Philadelphia, and colleagues sought to describe the identification and management of cardiovascular risk factors among U.S. veterans with prostate cancer, including those initiating androgen deprivation therapy (ADT).
“Veterans with prostate cancer had a high rate of underassessed and undertreated cardiovascular risk facts, and ADT initiation was not associated with substantial improvements in cardiovascular risk factor assessment or management,” the investigators commented.
The analysis included 90,494 men who had been diagnosed with prostate cancer and treated by the U.S. Veterans Health Administration from 2010 to 2017. The median patient age was 66 years. Approximately 25% of participants (n = 22,700) received ADT. Among patients who had received comprehensive cardiovascular risk factor assessment (68.1%), uncontrolled risk factors were present in 54.1%, 29.6% were not receiving medication to reduce the risk. Patients with atherosclerotic cardiovascular disease who had not received ADT had a 10.4% higher chance of undergoing comprehensive assessment, a 4.0% lower risk of uncontrolled risk factors, and a 22.2% lower risk of untreated risk factors versus those who did not have atherosclerotic cardiovascular disease.
ADT did not seem to be associated with meaningful improvements in cardiovascular risk factor assessment or treatment. Patients with atherosclerotic disease who did receive ADT had similar outcomes as those who did not. However, patients without atherosclerotic cardiovascular disease who received ADT experienced only slight differences in outcomes, being 3.0% more likely to be comprehensively assessed, at a 2.6% higher risk of uncontrolled risk factors, and at 5.4% lower risk for untreated risk factors.
“These findings suggest the need for closer clinical attention and education, as well as innovative tools and interventions, to improve the stratification and mitigation of cardiac risk in patients with prostate cancer.,” concluded the study authors.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.