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1st March 2023
In men with prostate cancer, an international research group has found that just over half had three or more cardiovascular risk factors which are poorly controlled, highlighting a gap in care that requires attention.
It is recognised that men with prostate cancer (PC) have an elevated cardiovascular risk, with one study of nearly 2,500 male cancer patients, finding that two-thirds were deemed to be at high risk. Other research has revealed that cardiovascular causes of death can be greater than those of the cancer itself. For instance, a study of 752,092 men with PC identified that while 17% died because of their cancer, 83% died of other causes, of which, 23% were cardiac-related. Despite evidence that men with PC have a higher risk of cardiovascular-related death, which particular risk factors are present and how well these are controlled is unclear.
In the current study, researchers used data from the RADICAL-PC trial, a longitudinal prospective cohort study of men with PC. Information of demographics and clinical factors were collected from participant’s medical records although individuals also completed several lifestyle questionnaires and were assessed for frailty. Poor risk factor control for cardiovascular disease was defined in terms of low-density lipoprotein levels, physical activity, blood pressure control and a waist: hip ratio > 0.90.
Cardiovascular risk factor control in men with prostate cancer
A total of 2,811 men with a mean age of 68.3 years were included in the study and of whom, 91% had non-metastatic PC, with just over a third (38%) in receipt of androgen deprivation therapy. In addition, 23% of participants had pre-existing cardiovascular disease and virtually all (98%) had at least one poorly controlled cardiovascular risk factor. In fact, 51% of men had > 3 risk factors that were poorly controlled.
The researchers found that men with > 3 poorly controlled risk factors were generally older, had advanced cancer and were receiving androgen deprivation therapy. In multivariable analysis, there were four factors linked to having > 3 poorly controlled risk factors. Not taking a statin (odds ratio, OR = 2.55, 95% CI 2.00 – 3.26), physical frailty (OR = 2.37), the need for blood pressure medication (OR = 2.36) and finally increasing age (OR per 10-year increase = 1.34).
The authors concluded that poor cardiovascular risk factor control in men with prostate cancer is common and requires improved interventions to target the problem.
Klimis H et al. The burden of uncontrolled cardiovascular risk factors in men with prostate cancer. A RADICAL-PC analysis. J Am Coll Cardiol CardioOnc 2023