Dr Sieber on Comorbidities and the Risk of Cardiovascular Events in Prostate Cancer

Paul Sieber, MD, medical director, Clinical Trials, Keystone Urology, discusses the importance of assessing risk factors for cardiovascular events in patients with prostate cancer who are initiating androgen deprivation therapy (ADT).

A claims-based study, findings from which were presented at the 2023 AUA Annual Meeting, aimed to evaluate the likelihood of cardiovascular events in patients with prostate cancer who are receiving ADT and who have 1 or more of 3 common comorbidities: diabetes mellitus, hypertension, and hyperlipidemia.

This study included patients with prostate cancer who began ADT at least 12 months before enrollment and continued ADT for at least 6 months after enrollment. Patients were stratified by baseline comorbidity. Cardiac events, including stroke, myocardial infarction, unstable angina, thromboembolism, the need for coronary artery bypass graft, and the need for percutaneous coronary intervention were assessed in these patients for a maximum of 3 years after starting ADT.

In total, 7.6% and 7.3% of patients with only hypertension or hyperlipidemia, respectively, experienced cardiovascular events after ADT initiation, and 9.9% of patients with both hypertension and hyperlipidemia had a cardiovascular event. Additionally, 14.4% of patients with only diabetes experienced a cardiovascular event post-ADT initiation. However, patients who had all 3 comorbidities had the highest risk for a cardiovascular event after starting ADT; 16.1% of these patients experienced a cardiovascular event, with a hazard ratio of 2.15.

These findings can inform decision making regarding whether a patient with prostate cancer should receive ADT, Sieber says. If a patient being considered for ADT is receiving medication for hypertension, hyperlipidemia, and diabetes mellitus, they likely need a cardiac consultation, Sieber emphasizes. Although cardiac consultations are typically reserved for patients who need clearance for surgery, such as a radical prostatectomy, cardiac clearances may also be important for patients being considered for ADT, Sieber concludes.