Introduction: Androgen Deprivation Therapy (ADT) has been associated with increased cardiovascular (CV) risk. In 2021, the American Heart Association recommended baseline assessment of CV risk in patients starting ADT. To date, optimal evaluation and management has not been defined. A previous study examined how baseline risk factors could be aggregated as a risk score to assess possibility of future CV events. This analysis examined whether diabetes (DM), hypertension (HTN), hyperlipidemia (HLD) or their co-occurrences could predict the likelihood of a CV event in patients with prostate cancer (PC) initiating ADT. Methods: Using a US claims database, men diagnosed with PC and receiving ADT between 2010-2019 were identified. First ADT claim served as index date. Continuous enrollment =12 months prior and =6 months post index was required. Qualifying post-index CV events included hospitalization or emergency department visit with International Classification of Diseases (ICD)-9/10 or Current Procedural Terminology (CPT) codes for cerebrovascular accident, coronary bypass graft, myocardial infarction, percutaneous coronary intervention, thrombosis, and/or unstable angina. A Cox regression model including DM, HTN and HLD, identified by ICD codes, was used to examine time to first CV event. The analysis evaluated whether the presence of one, two or three of these baseline comorbidities, as mutually exclusive groups, was associated with higher risk for a CV event up to 3 years post ADT initiation. Results: Of the 10,530 men with PC and ADT, 934 (8.87%) experienced a CV event post-index. The Cox model showed, compared to patients with none of these comorbidities, the risk of CV events was greatest for patients with all three comorbidities [n=787 (7.47%); HR=2.15; p<0.001; 95% confidence interval (CI) 1.73-2.68]. Presence of two comorbidities also increased the risk [n=1,978 (18.78%); HR=1.36; p<0.001; CI 1.13-1.63]. Patients with only one comorbidity were not at increased risk for a CV event [n=2,721 (25.84%); HR=1.12; p=0.210; CI 0.94-1.33] compared to patients with no comorbidities. Conclusions: Presence of comorbidities—DM, HTN, and HLD—in men with PC starting ADT treatment, compared to men with none of these, was associated with greater risk for a CV event. Evaluating for presence of these frequent comorbidities could provide a simple, readily available framework for health care providers to identify patients with PC at greatest risk for CV events when starting on ADT. SOURCE OF Funding: Myovant Sciences GmBH in collaboration with Pfizer Inc.
