ASCO 2020: Assessment and Management of Cardiovascular Risk Factors Among US Veterans with Prostate Cancer-Initiating Androgen Deprivation Therapy

(UroToday.com) Cardiovascular disease is a leading cause of mortality in patients with prostate cancer. Androgen deprivation therapy (ADT) causes metabolic changes and may increase cardiac risks. It is recommended that cardiovascular risk factors are assessed to mitigate cardiovascular risk factors.

In this study, the authors aimed to determine the population-based adherence to screening and management of cardiovascular risk factors in prostate cancer patients, including those undergoing ADT.

This was a cross-sectional analysis of 191,829 US veterans newly diagnosed with prostate cancer from 2001-2017. Patients were classified by the initiation of ADT within a year of diagnosis and prior history of atherosclerotic cardiovascular disease. The authors also determined the rates of complete cardiovascular risk factor assessment, including assessment of measured blood pressure values, cholesterol, and glucose in an 18 months baseline. The goal was to assess the risk difference regression in an attempt to assess the impact of ADT initiation before atherosclerotic cardiovascular disease, on the risk of unassessed, uncontrolled and untreated cardiovascular risk factors (Figure 1).

The baseline characteristics of the patients are shown in Table 1, and Figure 2 demonstrates the proportion of US veterans with prostate cancer who had complete cardiovascular risk factor assessment over time. A total of 54.6% of the patients completed a cardiovascular risk factor assessment, and this had improved from 26.1% in 2001 to 76.8% in 2017.

Figure 1 – Study flow diagram:

ASCO_2020_Cardiovascular_Risk_Factors_US_Veterans_with_Prostate_Cancer_1.png

Table 1 -Baseline characteristics of the patients:

ASCO_2020_Cardiovascular_Risk_Factors_US_Veterans_with_Prostate_Cancer_2.png

Figure 2 – Proportion of US veterans with prostate cancer who had complete cardiovascular risk factor assessment over time:

ASCO_2020_Cardiovascular_Risk_Factors_US_Veterans_with_Prostate_Cancer_3.png


Table 2 demonstrates the unadjusted proportions of unassessed, uncontrolled, and untreated for cardiovascular risk factors. Lastly, Table 3 demonstrates the risk difference regression of adjusted effects of ADT and atherosclerotic cardiovascular disease on the unassessed, uncontrolled, and untreated cardiovascular risk factors.

Table 2 - Unadjusted proportion: Unassessed, uncontrolled, and untreated cardiovascular risk factors:

ASCO_2020_Cardiovascular_Risk_Factors_US_Veterans_with_Prostate_Cancer_4.png

Table 3 – Risk difference regression: Adjusted effects of ADT and atherosclerotic cardiovascular disease on unassessed, uncontrolled, and untreated cardiovascular risk factors:

ASCO_2020_Cardiovascular_Risk_Factors_US_Veterans_with_Prostate_Cancer_5.png

The results demonstrate that compared to the reference group (patients with no history of atherosclerotic cardiovascular disease who did not receive ADT), men who did have a history of atherosclerotic cardiovascular disease had significantly lower risks of incomplete cardiovascular risk factor assessment, uncontrolled and untreated cardiovascular risk factors, regardless of ADT treatment. Men with a history of atherosclerotic cardiovascular disease who were treated with ADT had less than 5% difference in the risks assessed, uncontrolled, and untreated cardiovascular risk factors.

In conclusion, Veterans with prostate cancer with a high burden of cardiovascular risk factors that were modifiable had higher rates of unaddressed and untreated cardiovascular risk factors. More than one in five veterans did not have a complete cardiovascular risk factor assessment. Over half of the veterans had uncontrolled blood pressure, high cholesterol levels, and high glucose levels. Over 25% of patients with uncontrolled cardiovascular risk factors received a corresponding risk-reducing medication. The cardiac risk was appropriately assessed and managed more closely in veterans with poor atherosclerotic cardiovascular disease. Lastly, treatment with ADT was not associated with clinically meaningful higher rates of cardiovascular risk factors assessment or treatment.  

Presented by: Lova Sun, MD, Fellow in the Division of Hematology and Oncology at the University of Pennsylvania, Philadelphia, Pennsylvania

Written by: Hanan Goldberg, MD, MSc., Urology Department, SUNY Upstate Medical University, Syracuse, NY, USA, @GoldbergHanan at the 2020 American Society of Clinical Oncology Virtual Annual Meeting (#ASCO20), May 29th-May 31st, 2020

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