Uncontrolled modifiable cardiovascular risk factors like suboptimal cholesterol, high blood pressure (BP) and diabetes may help identify those patients with prostate cancer who are more likely to benefit from a referral for routine cardiovascular care, according to findings from the RADICAL PC-2 trial presented at ESC Congress 2026 and simultaneously published in JACC: CardioOncology.

The trial enrolled nearly 2,500 participants with prostate cancer or receiving androgen-deprivation therapy at increased cardiovascular risk due to high cholesterol, hypertension and diabetes. Prespecified subgroup analyses were used to determine if certain patient groups derived greater benefit from specialist referral. Follow-up took place at three, six, 12, 18 and 24 months and then annually until the end of the study.

Primary outcomes included a hierarchical composite of cardiovascular death, myocardial infarction (MI), stroke, heart failure (HF), suboptimal cholesterol and systolic BP control, evaluated using the win ratio, as well as time to cardiovascular death, MI, stroke or HF.

Results found that all patients who were referred to a cardiologist or internist for structured cardiovascular risk factor and lifestyle modification, smoking-cessation, statin therapy and BP-lowering medication had more favorable outcomes overall, largely driven by improved cholesterol control. No differences were observed in rates of primary outcome events.

Broken down by risk factors, the treatment effect differed by baseline total cholesterol (≤4 mmol/L vs. >4 mmol/L), and by baseline BP status (systolic BP ≥130 mm Hg or diastolic BP ≥80 mm Hg vs. BP <130/80 mm Hg). The interaction for diabetes did not reach statistical significance, although the intervention effect estimates suggested a potential difference by diabetes status, according to researchers.

“The major findings from this stratified analysis of a large, pragmatic, international, randomized controlled trial of a structured cardiovascular intervention for patients with prostate cancer are that more favorable intervention estimates were observed among participants with total cholesterol >4 mmol/L, self-reported hypertension or elevated baseline BP (systolic BP ≥130 mm Hg or diastolic BP ≥80 mm Hg), and possibly diabetes,” said Cristina Cano Garcia, MD, and Jehonathan Pinthus, MD, PhD, et al.

“This important international study works to establish an evidence base of who benefits and how they may benefit from cardiovascular and internist management of risk,” said Bonnie Ky, MD, MSCE, FACC, editor-in-chief of JACC: CardioOncology.

Visit the JACC Journals at ESC Congress 2026 page to see the full list of simultaneous publications.

Clinical Topics: Cardiovascular Care Team, Heart Failure and Cardiomyopathies, Prevention, Acute Heart Failure, Hypertension

Keywords: ESC Congress, ESC26, Cardio-oncology, Myocardial Infarction, Hypertension, Heart Failure, Diabetes Mellitus, Stroke