Cardiovascular risk assessment in patients commenced on androgen deprivation therapy for prostate cancer - under-recognised and under-treated?

Abstract

Background Androgen Deprivation Therapy (ADT) reduces prostate cancer (PC) mortality but is associated with increased cardiovascular risk (CVR). We investigated baseline CVR in PC patients starting ADT and if it was optimized at initiation. Methods This retrospective study included PC patients initiated on ADT at Monash Health, Australia (2020-2023). Baseline demographics, CVR factors, PC history, medications, and CV events were collected from medical records. Patients who had CVR assessment and medication optimization were reported as frequency/percentages. Results 203 patients (70.5+/-9.2 years) were initiated on ADT and included in the study (38% initiated on ADT by radiation oncologists, 31% by urologists and 26% by medical oncologists). Many had CVR factors at baseline (30% diabetes, 69% hypertension, 52% current/ previous smoking) and 25% had ischemic heart disease. Only 14% had medical documentation of CVR, 2% prescribed CV medications and 4% (n=8) were referred to cardiology clinics (no differences between specialties). CVR prediction scores could be only applied to 1.7% (n=2) of patients due to incomplete baseline measurements. Of patients with previous IHD, only 38% were on all guideline recommended secondary prevention medications. Conclusion Patients with PC initiated on ADT have increased CV risk which is under recognized and untreated at initiation. A multidisciplinary approach involving cardio-oncology services may improve CV outcomes and reduce treatment complications. [Formula presented]Copyright © 2025 American College of Cardiology Foundation