Major adverse cardiovascular events risk after androgen deprivation therapy initiation is higher for older patients
David E. Crawford1, Deborah M. Boldt-Houle2, Stuart N. Atkinson2, J. Curtis Nickel3.
1Grand Rounds in Urology, Koman Family Outpatient Pavilion, La Jolla, CA, United States; 2Medical Affairs, Tolmar Pharmaceuticals, Inc.,, Buffalo Grove, IL, United States; 3Urology, Queen's University, Kingston, ON, Canada
Introduction: Patients with prostate cancer (PCa) treated with androgen deprivation therapy (ADT) may experience major adverse cardiovascular events (MACE).1,2 However, there is some debate as to how much of MACE is caused by ADT itself. One risk factor that might influence MACE is increasing age. A study in the general population found that the rate of cardiovascular (CV) disease was approximately 15% higher for individuals 80 years and older compared to those 60–79 years old (90% and 91% for men and women vs. 78% and 75% for men and women, respectively).3 This study evaluated real-world data from patients with PCa on ADT to understand the impact of increasing age on MACE risk.
Methods: Analyses of US electronic medical records (2010–2020) of PCa patients (n=45 059) receiving luteinizing hormone-releasing hormone (LHRH) agonist and antagonist injections were conducted to evaluate MACE risk following ADT initiation in the following age subgroups: <60, 60 to <70, 70 to <80, and ≥80 years old. The database contained 178 388 LHRH agonist and antagonist injection entries and 965 documented MACE events. Exclusion criteria included MACE within six months prior to ADT initiation. MACE was defined as myocardial infarction, stroke, and death from any cause based on a recent study in this field.4 Kaplan-Meier event-free survival curves were constructed to compare the MACE risk between age subgroups. Statistical significance between survival curves was evaluated by log-rank test.
Results: Overall MACE risk was 2.4% and 6.0% at one year and seven years following ADT initiation, respectively; 6%, 24%, 39%, and 31% of patients were <60, 60 to <70, 70 to <80, and ≥80 years old, respectively. MACE risk following ADT initiation was higher for older patients compared to younger patients (Figure 1). All comparisons were p<0.001 except for 60 to <70 years vs. <60 years (p<0.05).
Conclusions: MACE risk was higher for older patients in the first seven years after ADT initiation. This could be due to the likely increased prevalence of comorbidities that contribute to CV disease in elderly patients, such as diabetes,5 obesity,6 and frailty.7 Clinicians should be aware that age is a predisposing risk factor for CV disease in patients with PCa undergoing ADT and consider risk-reduction strategies. Future studies evaluating the role of comorbidities on CV risk for PCa patients during ADT may be helpful to identify other CV predictors.
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[7] 2021 Heart Disease & Stroke Statistical Update Fact Sheet. Older Americans & Cardiovascular Diseases. American Heart Association https://professional.heart.org/-/media/PHD-Files-2/Science-News/2/2021-Heart-and-Stroke-Stat-Update/2021_Stat_Update_factsheet_Older_and_CVD.pdf. Published 2021. Accessed January 10, 2022.
