The Burden of Uncontrolled Cardiovascular Risk Factors in Men With Prostate Cancer

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. (J Am Coll Cardiol CardioOnc 2023;5:70-81) (c) 2023 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).