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Assessment and Management of Cardiovascular Risk Factors Among US Veterans With Prostate Cancer

IMPORTANCE: Cardiovascular disease is a leading cause of mortality in patients with prostate cancer, and androgen deprivation therapy (ADT) may worsen cardiovascular risk. Adherence to guideline-recommended assessment and management of cardiovascular risk factors (CVRFs) in patients initiating ADT i...

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Autores principales: Sun, Lova, Parikh, Ravi B., Hubbard, Rebecca A., Cashy, John, Takvorian, Samuel U., Vaughn, David J., Robinson, Kyle W., Narayan, Vivek, Ky, Bonnie
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Medical Association 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7905496/
https://www.ncbi.nlm.nih.gov/pubmed/33625512
http://dx.doi.org/10.1001/jamanetworkopen.2021.0070
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author Sun, Lova
Parikh, Ravi B.
Hubbard, Rebecca A.
Cashy, John
Takvorian, Samuel U.
Vaughn, David J.
Robinson, Kyle W.
Narayan, Vivek
Ky, Bonnie
author_facet Sun, Lova
Parikh, Ravi B.
Hubbard, Rebecca A.
Cashy, John
Takvorian, Samuel U.
Vaughn, David J.
Robinson, Kyle W.
Narayan, Vivek
Ky, Bonnie
author_sort Sun, Lova
collection PubMed
description IMPORTANCE: Cardiovascular disease is a leading cause of mortality in patients with prostate cancer, and androgen deprivation therapy (ADT) may worsen cardiovascular risk. Adherence to guideline-recommended assessment and management of cardiovascular risk factors (CVRFs) in patients initiating ADT is unknown. OBJECTIVE: To describe CVRF assessment and management in men with prostate cancer initiating ADT and overall. DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional analysis of 90 494 men treated within the US Veterans Health Administration diagnosed with prostate cancer between January 1, 2010, and December 31, 2017, was conducted. Participants included men with a history of atherosclerotic cardiovascular disease (ASCVD), and treatment with ADT within 1 year of diagnosis. Data analysis was conducted from September 10, 2019, to July 1, 2020. MAIN OUTCOMES AND MEASURES: Rates of comprehensive CVRF assessment, uncontrolled CVRFs, and untreated CVRFs. Comprehensive CVRF assessment was defined as recorded measures for blood pressure, cholesterol, and glucose levels; CVRF control as blood pressure lower than 140/90 mm Hg, low-density lipoprotein cholesterol 130 mg/dL, and hemoglobin A(1c) less than 7%; and CVRF treatment as receipt of cardiac risk–reducing medications. Multivariable risk difference regression assessed the association between ASCVD and initiation of ADT and these outcomes. RESULTS: Of 90 494 veterans, median age was 66 years (interquartile range, 62-70 years); and 22 700 men (25.1%) received ADT. Overall, 68.1% (95% CI, 67.8%-68.3%) of the men received comprehensive CVRF assessment; 54.1% (95% CI. 53.7%-54.4%) of those assessed had uncontrolled CVRFs, and 29.6% (95% CI, 29.2%-30.0%) of those with uncontrolled CVRFs were not receiving corresponding cardiac risk–reducing medication. Compared with the reference group of patients without ASCVD not receiving ADT, patients with ASCVD not receiving ADT had a 10.4% (95% CI, 9.5%-11.3%) higher probability of comprehensive CVRF assessment, 4.0% (95% CI, 2.9%-5.1%) lower risk of uncontrolled CVRFs, and 22.2% (95% CI, 21.1%-23.3%) lower risk of untreated CVRFs. Similar differences were observed in patients with ASCVD receiving ADT. In contrast, patients without ASCVD receiving ADT had only a 3.0% (95% CI, 2.1%-3.9%) higher probability of comprehensive CVRF assessment, 2.6% (95% CI, 1.6%-3.5%) higher risk of uncontrolled CVRFs, and 5.4% (95% CI, 4.2%-6.6%) lower risk of untreated CVRFs. CONCLUSIONS AND RELEVANCE: These findings suggest that veterans with prostate cancer had a high rate of underassessed and undertreated CVRFs, and ADT initiation was not associated with substantial improvements in CVRF assessment or management. These findings highlight gaps in care and the need for interventions to improve CVRF mitigation in this population.
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spelling pubmed-79054962021-03-09 Assessment and Management of Cardiovascular Risk Factors Among US Veterans With Prostate Cancer Sun, Lova Parikh, Ravi B. Hubbard, Rebecca A. Cashy, John Takvorian, Samuel U. Vaughn, David J. Robinson, Kyle W. Narayan, Vivek Ky, Bonnie JAMA Netw Open Original Investigation IMPORTANCE: Cardiovascular disease is a leading cause of mortality in patients with prostate cancer, and androgen deprivation therapy (ADT) may worsen cardiovascular risk. Adherence to guideline-recommended assessment and management of cardiovascular risk factors (CVRFs) in patients initiating ADT is unknown. OBJECTIVE: To describe CVRF assessment and management in men with prostate cancer initiating ADT and overall. DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional analysis of 90 494 men treated within the US Veterans Health Administration diagnosed with prostate cancer between January 1, 2010, and December 31, 2017, was conducted. Participants included men with a history of atherosclerotic cardiovascular disease (ASCVD), and treatment with ADT within 1 year of diagnosis. Data analysis was conducted from September 10, 2019, to July 1, 2020. MAIN OUTCOMES AND MEASURES: Rates of comprehensive CVRF assessment, uncontrolled CVRFs, and untreated CVRFs. Comprehensive CVRF assessment was defined as recorded measures for blood pressure, cholesterol, and glucose levels; CVRF control as blood pressure lower than 140/90 mm Hg, low-density lipoprotein cholesterol 130 mg/dL, and hemoglobin A(1c) less than 7%; and CVRF treatment as receipt of cardiac risk–reducing medications. Multivariable risk difference regression assessed the association between ASCVD and initiation of ADT and these outcomes. RESULTS: Of 90 494 veterans, median age was 66 years (interquartile range, 62-70 years); and 22 700 men (25.1%) received ADT. Overall, 68.1% (95% CI, 67.8%-68.3%) of the men received comprehensive CVRF assessment; 54.1% (95% CI. 53.7%-54.4%) of those assessed had uncontrolled CVRFs, and 29.6% (95% CI, 29.2%-30.0%) of those with uncontrolled CVRFs were not receiving corresponding cardiac risk–reducing medication. Compared with the reference group of patients without ASCVD not receiving ADT, patients with ASCVD not receiving ADT had a 10.4% (95% CI, 9.5%-11.3%) higher probability of comprehensive CVRF assessment, 4.0% (95% CI, 2.9%-5.1%) lower risk of uncontrolled CVRFs, and 22.2% (95% CI, 21.1%-23.3%) lower risk of untreated CVRFs. Similar differences were observed in patients with ASCVD receiving ADT. In contrast, patients without ASCVD receiving ADT had only a 3.0% (95% CI, 2.1%-3.9%) higher probability of comprehensive CVRF assessment, 2.6% (95% CI, 1.6%-3.5%) higher risk of uncontrolled CVRFs, and 5.4% (95% CI, 4.2%-6.6%) lower risk of untreated CVRFs. CONCLUSIONS AND RELEVANCE: These findings suggest that veterans with prostate cancer had a high rate of underassessed and undertreated CVRFs, and ADT initiation was not associated with substantial improvements in CVRF assessment or management. These findings highlight gaps in care and the need for interventions to improve CVRF mitigation in this population. American Medical Association 2021-02-24 /pmc/articles/PMC7905496/ /pubmed/33625512 http://dx.doi.org/10.1001/jamanetworkopen.2021.0070 Text en Copyright 2021 Sun L et al. JAMA Network Open. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the CC-BY License.
spellingShingle Original Investigation
Sun, Lova
Parikh, Ravi B.
Hubbard, Rebecca A.
Cashy, John
Takvorian, Samuel U.
Vaughn, David J.
Robinson, Kyle W.
Narayan, Vivek
Ky, Bonnie
Assessment and Management of Cardiovascular Risk Factors Among US Veterans With Prostate Cancer
title Assessment and Management of Cardiovascular Risk Factors Among US Veterans With Prostate Cancer
title_full Assessment and Management of Cardiovascular Risk Factors Among US Veterans With Prostate Cancer
title_fullStr Assessment and Management of Cardiovascular Risk Factors Among US Veterans With Prostate Cancer
title_full_unstemmed Assessment and Management of Cardiovascular Risk Factors Among US Veterans With Prostate Cancer
title_short Assessment and Management of Cardiovascular Risk Factors Among US Veterans With Prostate Cancer
title_sort assessment and management of cardiovascular risk factors among us veterans with prostate cancer
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7905496/
https://www.ncbi.nlm.nih.gov/pubmed/33625512
http://dx.doi.org/10.1001/jamanetworkopen.2021.0070
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