Optimisation of cardiovascular risk factors in a dedicated cardio-oncology clinic for men with prostate cancer commencing androgen deprivation therapy

Background Patients with prostate cancer commenced on androgen deprivation therapy (ADT) have increased cardiovascular (CV) risk. Despite this, CV risk is often under-recognised and under-treated upon ADT initiation. Dedicated cardio-oncology (CO) services may facilitate systematic CV risk assessment and optimisation in this high-risk population. Purpose To investigate the feasibility and early outcomes of CV risk optimisation through a dedicated CO clinic in patients with prostate cancer receiving ADT. Method Patients with prostate cancer treated with ADT were reviewed prospectively in the dedicated CO clinics at a Victorian tertiary cardiac centre between 01/07/23–30/06/25. Data from electronic records collected on baseline CV comorbidities, cardiac investigations, medication changes, new CV diagnoses/interventions, mortality and trends in CV risk markers. Results 16 patients with 23 reviews (mean age 75.9±9.7years, median follow up 6.1±4.7months) were included. Baseline CV comorbidities were common (94% hypertension, 63% dyslipidaemia, 63% diabetes, 56% heart failure, 50% ischaemic heart disease, 50% with smoking history). 94% patients have CV medication modifications (total 38 modifications – 34% heart failure therapies, 24% statins, 18% antiplatelets/anticoagulants). Coronary artery disease was diagnosed in 6/8 patients without a pre-existing history. 2/16 patients required revascularisation (one patient needing percutaneous coronary intervention and one patient with coronary artery bypass grafting). During follow-up, median reductions were observed in total cholesterol (11.6%), LDL-cholesterol (18.3%), systolic blood pressure (12.4%) and HbA1c (2.1%). There was one cardiac admission and one cardiac-related death during follow up. Conclusion CV risk is elevated in patients with prostate cancer treated with ADT. CV risk optimisation can be feasibly achieved through a dedicated CO clinic which may have benefits in reducing CV complications.