South Central Section of the AUA 2022

SCS AUA 2022: Major Adverse Cardiovascular Events Risk After ADT Initiation Is Higher For Older Patients

( Patients with prostate cancer (PCa) treated with androgen deprivation therapy (ADT) may experience major adverse cardiovascular events (MACE). There is some debate as to how much of MACE is caused by ADT itself. Some risk factors that might influence MACE are increasing age and higher BMI. A study in the general population found that the rate of cardiovascular (CV) disease was approximately 15% higher for individuals 80 years and older compared to those 60 to 79 years old. This study evaluated MACE risk for PCa patients in different age and BMI groups using real-world data.

Analyses of US electronic medical records (2010 to 2020) of PCa patients receiving LHRHagonist and antagonist injections were conducted to calculate the risk of MACE since ADT initiation inthe following age (n=44,136) and BMI (n=36,249) subgroups: <60, 60 to <70, 70 to <80, and ≥80 years old;<18.5, 18.5 to <25, 25 to <30, 30 to <35, and >35 BMI. The database contained 178,388 LHRH agonist and antagonist injection entries and 965 documented MACE events. Exclusion criteria included MACE within 6 months prior to ADT initiation. MACE was defined as myocardial infarction, stroke, and death from any cause. Kaplan-Meier event-free survival curves were constructed to compare the MACE risk between age and BMI groups.

A total of 6%, 24%, 39%, and 31% of patients were <60, 60 to <70, 70 to <80, and ≥80 years old, respectively. MACE risk following ADT initiation was higher for older patients compared to younger patients.All comparisons were p<0.001 except for 60 to <70 years vs. <60 years (p<0.05). Differences in MACEincidence between BMI groups were not significant.

In summary, MACE risk was higher for older patients and similar across BMI subgroups after ADT initiation. A potential explanation for the age-related finding is likely the higher prevalence of co-morbidities that contribute to CV disease in elderly patients, such as diabetes, obesity, and frailty. The lack of significant differences in MACE risk across BMI subgroups is consistent with the literature that higher BMIs do not confer additional CV/MACE risk. These findings highlight critical competing risk assessment among all patients with cancer and importance of shared decision-making when formulating management plans. This especially holds true for patients considering undergoing ADT which may exacerbate MACEs.

Presented by: E. David Crawford, MD, Urologist, UC San Diego Health

Written by: Stephen B. Williams, MD, MBA, MS @SWilliams_MD on Twitter during the South Central Section American Urological Association Annual Meeting, September 6-10, 2022, Coronado, CA