Assessment and management of cardiovascular risk factors among U.S. Veterans with newly diagnosed prostate cancer.

Abstract

5510 Background: Cardiovascular disease (CVD) is a leading cause of death in men with prostate cancer (PC). Androgen deprivation therapy (ADT) is associated with increased CVD risk, and American Heart Association guidelines recommend CVD risk factor assessment and management in PC patients starting ADT. We characterized rates of guideline-concordant assessment and management of CVD risk factors for US Veterans with newly diagnosed PC, according to ADT use and prior atherosclerotic CVD diagnosis. Methods: We used cross-sectional data from VA Corporate Data Warehouse to identify Veterans with an incident diagnosis of PC from 2001-2017. Primary outcomes were guideline-concordant baseline CVD risk factor assessment (defined as ≥1 blood pressure, cholesterol, and HbA1c or fasting glucose measurement within 1 year prior to 6 months after ADT start or PC diagnosis), CVD risk factor control, and CVD risk-reducing medication use. Risk difference multivariable regression analyses adjusting for age, race, poverty, PC risk category, and year were used to evaluate the effect of ADT on study outcomes. Results: Of 191,829 Veterans with newly diagnosed PC, 27% (n = 51,419) were treated with ADT within 1 year of diagnosis, and 18% (n = 34,110) had a pre-existing diagnosis of atherosclerotic CVD. From 2001-2017, annual rates of guideline-concordant CVD risk factor assessment increased from 26% to 77%. In adjusted analyses, pre-existing atherosclerotic CVD diagnosis was associated with higher CVD risk factor assessment rate (64% vs 53%), better control of baseline LDL (94 vs 108 mg/dL), and higher rates of anti-hypertensive (90% vs 66%), lipid-lowering (83% vs 49%), and glucose-lowering (32% vs 20%) medication use. Treatment with ADT was associated with similar to minimally higher rates of CVD risk factor assessment (58% vs 54%), LDL control (104 vs 105 mg/dL), and anti-hypertensive (73% vs 69%), lipid-lowering (55% vs 55%), and glucose-lowering (25% vs 21%) medication use. Sixty percent of men starting ADT had at least one sub-optimally controlled CVD risk factor, and 1 in 4 of these men were not receiving a corresponding risk-reducing medication. One third of men starting ADT had BMI > 30 kg/m2. Conclusions: CVD risk factor assessment in Veterans with PC has increased over time. However, ADT does not appear to meaningfully impact CVD assessment or management, despite its known association with CVD risk. Over half of patients initiating ADT had elevated CVD risk factor(s). Multi-disciplinary efforts to improve CVD risk mitigation are needed among men initiating ADT.