Common Comorbidities Predict Incidence of Cardiovascular Events in Patients With Prostate Cancer Treated With Androgen Deprivation Therapy

Purpose: Cardiovascular disease (CVD) is the leading cause of death among patients with prostate cancer (PC). Androgen deprivation therapy (ADT) remains the standard of care for advanced PC. Since 2010, the U.S. FDA has required warning labels for gonadotropin-releasing hormone agonists about increased risk for diabetes and some CVDs. This observational, retrospective, real-world study evaluated the risks of a first cardiovascular event within 3 years after initiation of ADT in patients with PC, with or without the presence of ≥ 1 of 3 cardiometabolic comorbidities: diabetes mellitus (DM), hypertension, and hyperlipidemia. Materials and Methods: Retrospective data (2010-2019) from a large administrative U.S. claims data set were analyzed to examine risk of first cardiovascular event based on the presence/absence of target comorbidities, alone or combined, using Cox regression modeling. Results: Of 10,530 patients with PC receiving ADT, 934 (8.9%) experienced a postindex cardiovascular event. Compared with patients without any of the 3 comorbidities, risk of cardiovascular events was greatest for patients with all 3 comorbidities (hazard ratio [HR], 95% confidence interval [CI], 2.15 [1.73-2.68]; P < .0001), followed by those with DM alone (HR [95% CI], 1.72 [1.28-2.31]; P = .0003). Having DM + hypertension or hypertension + hyperlipidemia also increased risk of a cardiovascular event. Conclusions: Patients with PC and comorbid DM, hypertension, and hyperlipidemia treated with ADT are at increased risk of a cardiovascular event after ADT initiation compared with patients without these comorbidities. This study provides a straightforward method to evaluate men with PC before starting ADT to identify patients at greatest risk for experiencing a cardiovascular event.