The men with prostate cancer present a high risk of suffering from heart diseases, especially when receiving hormone therapy, according to a large international study, the first of its kind, led by researchers from McMaster University (Canada).
The findings have been simultaneously published in "JAMA Internal Medicine" and are being presented at the Congress of the European Society of Cardiology, held in Munich (Germany), by Darryl Leong, the principal investigator of the work and senior scientist at the Population Health Research Institute (PHRI), a joint center of Hamilton Health Sciences and McMaster University.
The study shows that systematic referrals to an internist or cardiologist managed to improve cholesterol levels, although they did not succeed in reducing the incidence of heart attacks, strokes, heart failure, or cardiovascular deaths.
The scientific team aimed to verify whether the involvement of a cardiologist or internist in the care of patients with prostate cancer could optimize the control of cardiovascular risk factors and reduce the occurrence of serious cardiac complications.
After close to six years of follow-up, the men referred to a cardiologist or internist, in addition to receiving standard oncological care for prostate cancer, had a significantly higher likelihood of being treated with statins (63% versus 40%) and antihypertensive drugs (56% versus 49%) than those who only received usual care. Over time, the referred group also showed significant decreases in cholesterol.
Despite these improvements in the management of risk factors, no relevant differences were detected between the groups in cardiovascular mortality, heart attack, stroke, or heart failure during the follow-up period. The authors point out that the number of participants who suffered these events was lower than expected, which complicates accurately assessing whether the referral strategy truly influenced these outcomes.
"I was surprised that we did not see a reduction in heart attacks, strokes, heart failure, or cardiovascular death in the group referred to a specialist," says Leong, director of the Cardio-Oncology Program at McMaster University and HHS, cardiologist at HHS, and associate professor in the Department of Medicine at McMaster.
Nevertheless, when examining the data in more detail, researchers detect a signal pointing to a possible decrease in heart attacks, consistent with the cholesterol-lowering effect observed. They emphasize that this indication must be confirmed through new studies.
The androgen deprivation therapy (ADT), a common treatment for prostate cancer, is associated with an increased risk of diabetes, high blood pressure, and cardiovascular disease. Although clinical guidelines recommend monitoring and treating these factors, there is little evidence on whether adding specific cardiovascular care to the approach for prostate cancer translates into better clinical outcomes.
"When someone is diagnosed with prostate cancer, the focus is usually on the cancer. But cardiovascular health is also important, especially for patients receiving hormonal therapy," says Leong. "We wanted to understand if the involvement of a cardiovascular specialist could help patients manage risk factors like cholesterol, blood pressure, and diabetes, adopt healthier habits and a healthier lifestyle, and ultimately improve their health."
The RADICAL PC 2 trial enrolled 2,501 men in eight countries (Canada, Brazil, Singapore, Colombia, India, Australia, Israel, and the United States) between 2015 and 2025. Participants had a recent diagnosis of prostate cancer or were starting androgen deprivation therapy for the first time.
In this study, patients were randomly assigned to two strategies: one group received only standard oncological care, while the other group added to that care a referral to an internist or cardiologist, who was asked to provide follow-up and management of cardiovascular risk factors.
A complementary work, released simultaneously in "JACC CardioOncology," identified men most likely to benefit from referral to a cardiology specialist. It was observed that those with blood pressure above 130/80, diabetes, or cholesterol above 4 mmol/L were the candidates with the most options to gain advantages.
Researchers conclude that these results underscore the need to systematically integrate the evaluation and management of cardiovascular risk factors into the routine care of patients with prostate cancer.