Getting to the Heart of Prostate Cancer: Identifying and Managing Cardiovascular Risk in Patients Receiving Androgen-Deprivation Therapy

So let's get the topic started with the first topic about understanding patient risk, cardiovascular risk, and prostate cancer, and are they inextricably linked? So what is the association of cardiovascular risk and prostate cancer? So prostate cancer is a journey.

It's a long disease which spans sometimes decades.

And what happens in prostate cancer is the burden, which is already present, Non-cancer death.

CVD is the leading cause of non-cancer death across all stages of prostate cancer.

Prostate cancer patients live long and longer survival leads to cumulative risk.

Longer survival with modern therapy makes cumulative CVD central to the outcomes and quality of life.

There is undiagnosed disease and shared drivers.

Many men with undiagnosed CVD at diagnosis and have shared risk factors such as age, obesity, smoking, etc.

And then therapy, which is given for prostate cancer, such as androgen deprivation therapy, AR pathway inhibitors, further elevate this cardiovascular risk and earning this recognition is essential.

So if you see the spectrum of the journey of a man with prostate cancer from localized prostate cancer, all the way to castration-resistant prostate cancer, the median survival is quite high.

Even those with biochemical relapse, the median survival, the five-year survival is above 90%.

So the clinical takeaway from that information is you have to reassess cardiovascular risk at each transition state as the balance of treatment benefit and risk may change as the patient's evolving prognosis changes from the prostate cancer standpoint.

So what are the key modifiable risk factors for heart disease in patients with prostate cancer?

Great question.

So in the next section, we'll talk about the patient-related factors, which could be their baseline risk factors, such as hypertension, diabetes, et cetera, and the treatment selection, which modifies their risk in a way which is unique to prostate cancer.

So when we see patients with prostate cancer, this manuscript highlighted what happens in terms of baseline risk factors.

Obesity is the strongest risk factor noted in these patients with about 91% patients with prostate cancer were noted to have high waist to hip ratio, which is a marker of obesity.

A lot of patients had high blood pressure, high cholesterol, and physical inactivity and tobacco use also present.

The key takeaway is prioritizing blood pressure, lipids, adiposity, activity, and tobacco exposure is important for men with prostate cancer.

We also note in the same study that 51% had at least three or more risk factors which are poorly controlled and 99%, which is essentially everyone had one uncontrolled cardiovascular risk factors.

So hence there are multiple poorly controlled risk factors just signal to intensify cardiovascular risk reduction and using a structured baseline review and that can coordinate comorbidity management.

So another thing to consider of the three poorly controlled cardiovascular risk factors is the patient's frailty status, their need for multiple medications, including blood pressure medication, whether they're taking a statin or not.

And this increase in age per 10 years increases their risk significantly.

So use these prompts to prompt targeted CV assessment and management.

So how can patient-related risk factors be modified? So that is important question because the patient-related risk factor modification is important for recognizing key gaps in cardiovascular disease prevention.

So let's get the topic started with the first topic about understanding patient risk, cardiovascular risk, and prostate cancer, and are they inextricably linked? So what is the association of cardiovascular risk and prostate cancer? So prostate cancer is a journey.

It's a long disease which spans sometimes decades.

And what happens in prostate cancer is the burden, which is already present, Non-cancer death.

CVD is the leading cause of non-cancer death across all stages of prostate cancer.

Prostate cancer patients live long and longer survival leads to cumulative risk.

Longer survival with modern therapy makes cumulative CVD central to the outcomes and quality of life.

There is undiagnosed disease and shared drivers.

Many men with undiagnosed CVD at diagnosis and have shared risk factors such as age, obesity, smoking, etc.

And then therapy, which is given for prostate cancer, such as androgen deprivation therapy, AR pathway inhibitors, further elevate this cardiovascular risk and earning this recognition is essential.

So if you see the spectrum of the journey of a man with prostate cancer from localized prostate cancer, all the way to castration-resistant prostate cancer, the median survival is quite high.

Even those with biochemical relapse, the median survival, the five-year survival is above 90%.

So the clinical takeaway from that information is you have to reassess cardiovascular risk at each transition state as the balance of treatment benefit and risk may change as the patient's evolving prognosis changes from the prostate cancer standpoint.

So what are the key modifiable risk factors for heart disease in patients with prostate cancer?

Great question.

So in the next section, we'll talk about the patient-related factors, which could be their baseline risk factors, such as hypertension, diabetes, et cetera, and the treatment selection, which modifies their risk in a way which is unique to prostate cancer.

So when we see patients with prostate cancer, this manuscript highlighted what happens in terms of baseline risk factors.

Obesity is the strongest risk factor noted in these patients with about 91% patients with prostate cancer were noted to have high waist to hip ratio, which is a marker of obesity.

A lot of patients had high blood pressure, high cholesterol, and physical inactivity and tobacco use also present.

The key takeaway is prioritizing blood pressure, lipids, adiposity, activity, and tobacco exposure is important for men with prostate cancer.

We also note in the same study that 51% had at least three or more risk factors which are poorly controlled and 99%, which is essentially everyone had one uncontrolled cardiovascular risk factors.

So hence there are multiple poorly controlled risk factors just signal to intensify cardiovascular risk reduction and using a structured baseline review and that can coordinate comorbidity management.

So another thing to consider of the three poorly controlled cardiovascular risk factors is the patient's frailty status, their need for multiple medications, including blood pressure medication, whether they're taking a statin or not.

And this increase in age per 10 years increases their risk significantly.

So use these prompts to prompt targeted CV assessment and management.

So how can patient-related risk factors be modified? So that is important question because the patient-related risk factor modification is important for recognizing key gaps in cardiovascular disease prevention.