Cardiovascular Risk in Prostate Cancer: Key Points
- Authors:
- Leong DP, Guha A, Morgans AK, Niazi T, Pinthus JH.
- Citation:
- Cardiovascular Risk in Prostate Cancer: JACC: CardioOncology State-of-the-Art Review. JACC CardioOncol 2024;6:835-846.
The following are key points to remember from a state-of-the-art review on cardiovascular (CV) risk in prostate cancer (PC):
- Patients with PC exhibit a significant prevalence of cardiovascular disease (CVD), with up to 20% having established CVD at diagnosis. Coronary artery disease, heart failure, and venous thromboembolism are notably more common in this group compared to the general population.
- Androgen deprivation therapy (ADT) increases CV risks through mechanisms such as increased adiposity, decreased muscle strength, and higher incidences of hypertension and diabetes. Clinicians should monitor and mitigate these risks.
- Gonadotropin-releasing hormone (GnRH) antagonists may present a lower risk of CV events compared to GnRH agonists, but further studies are necessary to confirm this.
- Androgen receptor pathway inhibitors (ARPIs) such as enzalutamide and abiraterone heighten risks of hypertension and fluid retention beyond those posed by GnRH agonists. Combining ARPIs with GnRH agonists warrants closer CV monitoring.
- Chronic inflammation may underlie both PC progression and CVD development. Anti-inflammatory strategies could have dual benefits in managing PC and reducing CV risk.
- Suboptimal control of hypertension, hyperlipidemia, and diabetes is prevalent among PC patients. Enhanced collaboration between oncology, cardiology, and primary care teams can address these gaps more effectively.
- Annual CV risk assessment is recommended for PC patients receiving ADT, including evaluations of lipids, glucose, renal function, and electrocardiograms. Enhanced focus is needed for patients with pre-existing CV conditions.
- Interventions targeting smoking cessation, regular physical activity, and a heart-healthy diet should be integrated into routine PC care to address modifiable CV risk factors.
- Existing tools like the SCORE2 risk stratification model lack validation for PC populations. Developing and using cancer-specific CV risk prediction models is a priority for personalized care.
- GnRH antagonists and combination therapies with cardioprotective agents such as statins and antihypertensive agents offer potential but require further validation in randomized trials.
Clinical Topics: Cardio-Oncology, Prevention
Keywords: Cardio-oncology, Heart Disease Risk Factors, Prostatic Neoplasms
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