Many male veterans with prostate cancer (PCa), including those initiating androgen deprivation therapy (ADT), have a high burden of cardiovascular risk factors that is not adequately addressed by their healthcare providers, a new study finds.
Of 90,494 men with PCa (median age 66 years) within the US Veterans Health Administration during 2010 to 2017, only 68.1% received a comprehensive cardiovascular risk factor assessment of their blood pressure, cholesterol, and glucose levels, corresponding authors Lova Sun, MD, and Bonnie Ky, MD, of the University of Pennsylvania in Philadelphia, Pennsylvania, and colleagues reported in JAMA Network Open. A total of 54.1% of veterans had uncontrolled blood pressure higher than 140/90 mm Hg, low-density lipoprotein cholesterol higher than 130 mg/dL, or hemoglobin A1c higher than 7%. Yet 29.6% of these men did not receive risk-reducing medications. Specifically, 21.3% of patients with uncontrolled blood pressure did not receive antihypertensive medications, 47.6% of patients with uncontrolled cholesterol levels did not receive lipid-lowering therapy, and 8.1% of patients with uncontrolled blood glucose levels did not receive antihyperglycemic drugs, the investigators reported.
Patients with a history of atherosclerotic cardiovascular disease (ASCVD) had just a 10.4% higher probability of having a comprehensive assessment, 4.0% lower risk of uncontrolled cardiovascular risk factors, and 22.2% lower risk of receiving no indicated treatments compared with patients who had no ASCVD history and were not receiving ADT (reference group).
Although ADT possibly worsens cardiovascular risks, male veterans receiving ADT (25.1% of the cohort) without ASCVD had only a 3.0% higher probability of a comprehensive cardiovascular risk assessment compared with the reference group. These ADT users had a 2.6% higher risk of uncontrolled risk factors, but a 5.4% lower risk of receiving no treatment. Veterans at higher cardiovascular risk due to both ASCVD and ADT had just a 2.2% lower risk of uncontrolled risk factors than veterans without ASCVD and ADT. According to the investigators, these findings suggest that ASCVD history, not ADT use, was associated with closer cardiovascular risk management.
“Because monitoring and mitigation of [cardiovascular risk factors] are essential to improving survivorship care in patients with prostate cancer, most of whom are treated with curative intent and have prolonged life expectancies, our findings underscore the need for improved clinician and patient education, as well as interventions to optimize cardiac risk management,” the study authors wrote. “These efforts may emphasize multidisciplinary collaboration between oncologists, radiation oncologists, urologists, primary care physicians, and cardiologists.”
Sun L, Parikh RB, Hubbard RA, et al. Assessment and management of cardiovascular risk factors among US veterans with prostate cancer. JAMA Netw Open. Published online February 244, 2021. 2021;4(2):e210070. doi:10.1001/jamanetworkopen.2021.0070