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Prostate Cancer: Identifying Patients at Risk for CVD


A brief review of factors that may put patients with prostate cancer at increased risk for developing cardiovascular disease.


John L. Fox, MD, MHA: I think the holy grail of all of medicine is to identify patients who are at higher risk compared to those who are at lower risk, where we can incorporate that information into our treatment decisions. In the prostate cancer space, there are no cardiac biomarkers to suggest which patients are at higher or lower risk. There are certainly historical markers and physiologic markers, like lipids, but there are no cardiac biomarkers, per se. However, there was one study published in 2021 that looked at N-terminal pro-B-type natriuretic peptide [pro-BNP] and high-sensitivity troponin as indicators of cardiovascular risk. They showed that in patients who had these elevated markers, these were associated with the development of new cardiovascular events, especially in patients who were getting GnRH [gonadotropin-releasing hormone] agonists. But notably, when those biomarkers were high, patients with those elevated biomarkers who got GnRH antagonists did not have an increased risk of new cardiovascular events. So I think that the jury is still out on whether there are biomarkers that should be incorporated into clinical practice. I would say the answer is probably not today, but we continue to look for things that will help us stratify patients and conform our treatment decisions to those biomarkers.

Bhavesh Shah, RPh, BCOP: For every patient with prostate cancer who starts ADT [androgen deprivation therapy] therapy, we basically make sure they are on this health path, we put the fear of God in them that they’re going to have increased risk of cardiovascular events. They need to basically stop smoking, better manage their diabetes, change their diet, and manage their cholesterol better, all of the things we do to counsel the patient. In terms of the question of who are the patients at high risk, it’s really those patients with preexisting cardiovascular events. Those patients probably have a much higher risk. I think we should focus on those patients more closely than the patients who don’t have the preexisting cardiovascular disease. We know from the literature that about 30% of patients who are diagnosed with prostate cancer are going to have preexisting cardiovascular disease. So, it’s really important to think about those patients differently and be more aggressive in the care of those patients and preventing those further events.

Transcript edited for clarity.

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