Veterans with Prostate Cancer Are Underassessed And Undertreated For Cardiovascular Risk Factors

Veterans with prostate cancer had a high rate of underassessed and undertreated cardiovascular risk factors (CVRFs), according to data from a recent cross-sectional analysis published in JAMA Oncology.

Further, the initiation of androgen deprivation therapy (ADT) for the prostate cancer did not improve CVRF assessment or management.

CVRFs and atherosclerotic cardiovascular disease (ASCVD) are some of the leading causes of death in men with prostate cancer. The study authors noted that the mitigation of CVRFs in patients with cancer may help improve survival. However, ADT, a standard and effective treatment for prostate cancer, has been associated with an increased risk of diabetes, metabolic syndrome and ASCVD.

“In addition, men receiving ADT may already be at higher cardiac risk because shared risk factors, such as smoking and obesity, are associated with both cardiovascular disease and high-risk for prostate cancer,” the authors wrote.

To determine whether cardiovascular risk factors are assessed and appropriately managed in patients with prostate cancer who undergo ADT, the researchers performed a cross-sectional analysis of U.S. veterans diagnosed with prostate cancer from 2010 to 2017.

The final analysis examined 22,700 patients who received ADT and 67,794 patients who did not. Patients who received ADT were typically older than those who didn’t (median age of 67 years old versus 65), had a history of ASCVD (21% versus 15.5%) and had metastatic or node-positive disease (23.2% versus 1.6%). Of all the patients, 78.1% were overweight or obese.

Only 68.1% of veterans received a comprehensive CVRF assessment, meaning they had recorded measures for blood pressure, cholesterol and glucose levels. For patients with known ASCVD, the adjusted proportion of comprehensive CVRF was 78.2% in ADT-treated patients and 76.2% in untreated patients. There were lower adjusted proportions of CVRF assessment in patients without ASCVD, with 68.8% in ADT-treated patients and 65.8% in untreated patients. The results suggest that comprehensive CVRF assessment was associated with ASCVD status as opposed to planned ADT.

Of the veterans, 54.1% had at least one uncontrolled CVRF (such as high blood pressure, cholesterol levels or glucose levels). Of the patients with uncontrolled CVRFs, 29.6% were not receiving a corresponding risk-reducing medication. The results suggest that ASCVD history was associated with closer cardiovascular risk management, not ADT.

The researchers found that ADT was not associated with higher rates of CVRF assessment or treatment despite increasing awareness regarding the cardiovascular effects of ADT, especially for patients with known ASCVD. They noted that this may be attributed to perceived controversy regarding the relationship between ADT and adverse cardiovascular events, since some studies have not shown an association.

Additionally, patients treated with ADT are more likely to experience side effects that may take up time of clinical care at the cost of asymptomatic but important toxic reactions.

“Our findings underscore the need for improved clinician and patient education, as well as interventions to optimize cardiac risk management,” the authors concluded.

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