Racial differences in new-onset cardiovascular disease in men with prostate cancer treated with hormone therapy

INTRODUCTION Cardiovascular disease is the leading cause of death in patients with prostate cancer. Despite its efficacy in the treatment of advanced prostate cancer, androgen deprivation therapy (ADT) has been associated with increased cardiovascular disease mortality. Given black men have elevated risk of cardiovascular disease mortality compared to other racial groups, this study sought to evaluate the relationship of race with ADT-associated cardiotoxicity. METHODS We conducted a retrospective chart review of patients with locally advanced and metastatic prostate cancer who received androgen deprivation therapy at a single institution from 2017 to 2022. Methods of ADT included gonadotropin-releasing hormone agonists/antagonists, non-steroidal anti-androgens, and bilateral orchiectomy. Patients were identified using International Classification of Diseases diagnosis and procedure codes. Data was collected on patient demographics, details regarding prostate cancer staging and treatment, as well as cardiovascular diagnoses and events, both proceeding and following hormone treatment initiation. RESULTS A total of 119 patients met inclusion criteria, including 94 black men and 25 white men. Median age at time of diagnosis was 68 and 63, for black and white men respectively. The groups did not differ with respect to stage at diagnosis and treatment history including radical prostatectomy, radiation, and chemotherapy as well as type of ADT administered. Median follow up was 4.0 and 4.7 years in the white and black cohorts. Mean duration of androgen deprivation therapy was similar in white and black men (8.37 v. 7.0 years, p = 0.38, ANOVA). Prevalence of pre-existing cardiovascular diagnoses prior to starting androgen deprivation therapy was similar between the two groups prior to starting ADT treatment (28% v. 35%, p = 0.5, ANOVA). After initiating ADT, black men had greater likelihood of developing new cardiovascular diagnoses (46% v. 24%, p = 0.05, ANOVA), with a trend toward higher rate of coronary angioplasty/bypass procedures in black men (9.5% v. 4%, p 0.12, ANOVA). All recorded 8 deaths were in patients who identified as black; cardiovascular disease was the cause of death in 5 of the 8 patients (3 cerebrovascular accidents, 1 myocardial infarction, 1 pulmonary embolism). 2 of the 3 cerebrovascular accidents occurred in patients with no pre-existing cardiovascular history prior to initiation of ADT. CONCLUSIONS This data suggests a higher incidence of cardiovascular morbidity in black men on androgen deprivation therapy and may translate to a higher risk of cardiovascular mortality