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UPJ INSIGHT Androgen Deprivation Therapy and Cardiovascular Risk in Prostate Cancer

By: Benjamin Lowentritt, MD, Chesapeake Urology, United Urology Group, Towson, Maryland, Urology and Urology-Oncology, GBMC Healthcare Inc, Towson, Maryland; Mark Fallick, MD, MBA, Myovant Sciences, Inc, Brisbane, California; Janis Pruett, EdD, RN, MSN, FNP-BC, Now with Sumitomo Pharma America, Inc, Marlborough, Massachusetts; Tao Jiang, PhD, Charles River Associates, Boston, Massachusetts; Eddie Li, MS, Charles River Associates, Boston, Massachusetts; Bruce Brown, MD, Aura Biosciences, Inc, Boston, Massachusetts; Robert Dufour, PhD, Myovant Sciences, Inc, Brisbane, California | Posted on: 19 Jan 2024

Lowentritt B, Fallick M, Pruett J, et al. Incidence of Cardiovascular Events in Patients With Prostate Cancer and Treated With Androgen Deprivation Therapy. Urol Pract. 2024;11(1):153-162.

Study Need and Importance

Androgen deprivation therapy (ADT) remains the foundation of advanced prostate cancer (PC) treatment. Since 2010, the Food and Drug Administration has required warnings for risk of diabetes and certain cardiovascular diseases (CVDs) in labeling of gonadotropin-releasing hormone receptor agonists. In 2021, the American Heart Association recommended baseline assessment of cardiovascular (CV) risk in men starting ADT. However, optimal evaluation and management of CV risks remain to be defined.

What We Found

This observational, retrospective, real-world study (N = 10,530) used data from a large administrative US claims dataset (2010-2019) to evaluate time to a first CV event within 3 years postinitiation of ADT in PC patients, while controlling for baseline CVD history and risk factors (eg, diagnosis of diabetes, hypertension, etc).

The current analysis indicated that patients with a baseline history of CVD had increased risk of CV events within 3 years of ADT initiation vs those without baseline CVD history (Figure). Increased length of exposure to a gonadotropin-releasing hormone agonist and higher CV risks, as documented in this study, were also associated with increased risk of CV events during the follow-up period.

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Figure. Kaplan-Meier curves of time to initial cardiovascular (CV) event within the 3-year follow-up period, by baseline cardiovascular disease (CVD) history. ADT indicates androgen deprivation therapy.

Limitations

Limitations common to retrospective studies using administrative claims data apply to this study and include lack of certain information in the database (eg, family history, health behaviors, severity of preexisting CVD, etc) and errors in claims coding.

Interpretation for Patient Care

PC patients with a history of CVD and who are treated with chemical ADT are at increased risk of a CV event within 3 years of ADT initiation compared with those with no history of CVD. Understanding the impact of ADT therapy on CV risk is critical to help patients achieve optimal outcomes during PC treatment.

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