Cardiovascular Disease in a Population-Based Cohort of Prostate Cancer Patients With Long-Term Follow-Up

Abstract

Introduction: Prostate cancer is the most common malignancy among men in the United States. Few studies have evaluated cardiovascular disease (CVD) risk comprehensively among prostate cancer patients with treatment dose-response assessments. The primary aim of our study is to estimate the incidence of CVDs among prostate cancer patients compared to the general population cohort. A secondary aim is to investigate socioeconomic status (SES) and clinical risk factors for CVD among prostate cancer patients.

Patients and methods: Cohorts of 18,134 cancer patients with prostate adenocarcinomas diagnosed between 2004 and 2017 and 73,470 men without cancer matched on age, birth state, and follow-up time were identified. CVD diagnoses were identified from electronic medical records and statewide healthcare facilities data. Cox proportional hazard models were used to estimate hazard ratios, adjusted for potential confounders after evaluation.

Results: The risks of CVDs, including hypertension, arterial diseases, and venous diseases, among prostate cancer survivors compared to the general population were increased for all follow-up periods after cancer diagnosis. The risk of CVD was increased with obesity, baseline comorbidities, lower SES, and advanced-stage cancer, and differed by first-course cancer treatment, with CVD risks higher for androgen deprivation therapy (ADT) and conservative treatment. We also observed that increasing duration of ADT was associated with an increased risk of arterial diseases.

Conclusion: We found an increased risk of CVDs that lasted through 10 to 16 years post-prostate cancer diagnosis. Lifestyle interventions to decrease the risk of CVDs in prostate cancer survivors may be potentially beneficial to increasing life expectancy.

Keywords: Androgen deprivation therapy; Cardiovascular disease; Prostate cancer; Socioeconomic status; Survivorship.