The Burden of Uncontrolled Cardiovascular Risk Factors in Men With Prostate Cancer: A RADICAL-PC Analysis

Harry Klimis; Jehonathan H Pinthus; Nazanin Aghel; Emmanuelle Duceppe; Vincent Fradet; Ian Brown; D Robert Siemens; Bobby Shayegan; Laurence Klotz; Patrick P Luke; Tamim Niazi; Luke T Lavallee; Negareh Mousavi; Robert J Hamilton; Joseph L Chin; Darin Gopaul; Philippe D Violette; Margot K Davis; Nawar Hanna; Robert Sabbagh; Osnat Itzhaki Ben Zadok; Ludhmila Abrahão Hajjar; Ariel Galapo Kann; Rajibul Mian; Sumathy Rangarajan; Kelvin Kuan Huei Ng; Zaza Iakobishvili; Joseph B Selvanayagam; Alvaro Avezum; Darryl P Leong

doi:10.1016/j.jaccao.2022.09.008

The Burden of Uncontrolled Cardiovascular Risk Factors in Men With Prostate Cancer: A RADICAL-PC Analysis

JACC CardioOncol. 2023 Jan 17;5(1):70-81. doi: 10.1016/j.jaccao.2022.09.008. eCollection 2023 Feb.

Authors

Harry Klimis¹, Jehonathan H Pinthus², Nazanin Aghel^{1

3}, Emmanuelle Duceppe⁴, Vincent Fradet^{5

6

7}, Ian Brown⁸, D Robert Siemens^{9

10

11}, Bobby Shayegan¹², Laurence Klotz¹³, Patrick P Luke¹⁴, Tamim Niazi¹⁵, Luke T Lavallee¹⁶, Negareh Mousavi¹⁷, Robert J Hamilton¹⁸, Joseph L Chin¹⁹, Darin Gopaul²⁰, Philippe D Violette^{2

21}, Margot K Davis²², Nawar Hanna²³, Robert Sabbagh²⁴, Osnat Itzhaki Ben Zadok²⁵, Ludhmila Abrahão Hajjar²⁶, Ariel Galapo Kann²⁷, Rajibul Mian¹, Sumathy Rangarajan¹, Kelvin Kuan Huei Ng³, Zaza Iakobishvili²⁸, Joseph B Selvanayagam^{29

30}, Alvaro Avezum²⁷, Darryl P Leong¹

Affiliations

¹ Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada.
² Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
³ Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada.
⁴ Department of Medicine, University of Montreal, Montreal, Quebec, Canada.
⁵ Department of Surgery, Université Laval, Quebec, Canada.
⁶ Research Center of CHU de Québec, Université Laval, Oncology Axis, Quebec, Canada.
⁷ CHU de Québec, Site L'Hôtel-Dieu de Québec, Quebec, Canada.
⁸ Division of Urology, Niagara Health System, Saint Catharines, Ontario, Canada.
⁹ Queen's Cancer Research Institute, Kingston, Ontario, Canada.
¹⁰ Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada.
¹¹ Department of Urology, Queen's University, Kingston, Ontario, Canada.
¹² Department of Surgery, Division of Urology, St Joseph's Healthcare, McMaster University, Hamilton, ON, Canada.
¹³ Department of Surgery, Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
¹⁴ Department of Surgery, Division of Urology, London Health Sciences Centre, Western University, London, Ontario, Canada.
¹⁵ Radiation Oncology Department, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
¹⁶ Division of Urology, Department of Surgery, The Ottawa Hospital, The University of Ottawa, Ottawa, Ontario, Canada.
¹⁷ Department of Medicine, Division of Cardiology, McGill University Health Center, Montreal, Quebec, Canada.
¹⁸ Department of Surgery, Division of Urology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada.
¹⁹ Department of Urology, University of Western Ontario, London Health Sciences Centre, London, Ontario, Canada.
²⁰ Department of Medicine, Division of Radiation Oncology, Grand River Regional Cancer Centre, Kitchener, Ontario, Canada.
²¹ Woodstock Hospital, Woodstock, Ontario, Canada.
²² Department of Medicine, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
²³ Department of Surgery, Division of Urology, CIUSSS de l'Est-de-l'Île-de-Montréal, Installation Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada.
²⁴ Department of Surgery, Division of Urology, Université de Sherbrooke, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada.
²⁵ Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel.
²⁶ Department of Cardiology, Instituto do Coração, Universidade de São Paulo, São Paulo, Brazil.
²⁷ Hospital Alemão Oswaldo Cruz, São Paulo, Brazil.
²⁸ Department of Community Cardiology, Tel Aviv Jaffa District, Clalit Health Fund and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
²⁹ Department of Medicine, School of Medicine and Public Health, Flinders University, Adelaide, Australia.
³⁰ Department of Heart Health, South Australian Health and Medical Research Institute, Adelaide, Australia.

Abstract

Background: Cardiovascular disease (CVD) incidence is higher in men with prostate cancer (PC) than without.

Objectives: We describe the rate and correlates of poor cardiovascular risk factor control among men with PC.

Methods: We prospectively characterized 2,811 consecutive men (mean age 68 ± 8 years) with PC from 24 sites in Canada, Israel, Brazil, and Australia. We defined poor overall risk factor control as ≥3 of the following: suboptimal low-density lipoprotein cholesterol (>2 mmol/L if Framingham Risk Score [FRS] ≥15 and ≥3.5 mmol/L if FRS <15), current smoker, physical inactivity (<600 MET min/wk), suboptimal blood pressure (BP) (≥140/90 mm Hg if no other risk factors, systolic BP ≥120 mm Hg if known CVD or FRS ≥15, and ≥130/80 mm Hg if diabetic), and waist:hip ratio >0.9.

Results: Among participants (9% with metastatic PC and 23% with pre-existing CVD), 99% had ≥1 uncontrolled cardiovascular risk factor, and 51% had poor overall risk factor control. Not taking a statin (odds ratio [OR]: 2.55; 95% CI: 2.00-3.26), physical frailty (OR: 2.37; 95% CI: 1.51-3.71), need for BP drugs (OR: 2.36; 95% CI: 1.84-3.03), and age (OR per 10-year increase: 1.34; 95% CI: 1.14-1.59) were associated with poor overall risk factor control after adjustment for education, PC characteristics, androgen deprivation therapy, depression, and Eastern Cooperative Oncology Group functional status.

Conclusions: Poor control of modifiable cardiovascular risk factors is common in men with PC, highlighting the large gap in care and the need for improved interventions to optimize cardiovascular risk management in this population.

Keywords: ADT, androgen deprivation therapy; BP, blood pressure; CVD, cardiovascular disease; ECOG, Eastern Cooperative Oncology Group; GnRH, gonadotropin-releasing hormone; HDL, high-density lipoprotein; HbA1c, glycosylated hemoglobin; LDL, low-density lipoprotein; PC, prostate cancer; PHQ-9, Patient Health Questionnaire-9; PSA, prostate-specific antigen; androgen deprivation therapy; cardiovascular disease prevention; cardiovascular risk; prospective; prostate cancer.