Association of hormone therapy usage with adverse cardiovascular events in prostate cancer patients of the All of Us Research Programcohort.

Abstract

5021 Background: Hormone therapies (HT) such as GnRH agonists, GnRH antagonists, and/or anti-androgens have led to improved overall survival for prostate cancer patients. However, the usage of these drugs may also increase cardiovascular (CV) risk. Methods: This study examined participants in the All of Us Research Program who were diagnosed with prostate cancer, had no prior history of adverse cardiovascular events (ACE), and were either treated or not treated with HT. We defined ACE as myocardial infarctions, strokes, or heart failure. Covariates used in our analysis were age, dyslipidemia, type 2 diabetes, hypertension, chronic kidney disease, peripheral vascular disease, statin usage, and smoking history. Time-to-ACE was defined using longitudinal electronic health record data. Participants who did not develop ACE were right censored at the date of their last medical visit. We evaluated whether HT use affected the risk of ACE using a Cox proportional hazards model with adjustment for established CV risk factors as covariates. Results: The final cohort included 5156 All of Us participants. Of these participants, 851 received HT treatment, 624 received only non-HT treatment (other medical, radiation, or surgical treatment for their prostate cancer), and 3681 received no known treatment. In our overall survival analysis, HT was associated with increased risk of ACE (HR, 1.22; 95% CI, 1.01-1.48; P = 0.03). In participants with pre-treatment dyslipidemia (Table), HT usage was associated with increased risk of ACE (HR, 1.52; 95% CI, 1.19-1.95; P <0.001). In participants without pre-treatment dyslipidemia, no association was found between HT usage and ACE (HR, 0.96; 95% CI, 0.71-1.30; P = 0.81). Conclusions: In a study cohort with no prior history of ACE, HT was associated with increased risk of ACE in participants with pre-treatment dyslipidemia. These results suggest that risk stratification by dyslipidemia status may help improve CV outcomes when selecting treatment regimens for prostate cancer patients. Cox model for adverse cardiovascular time-to-event stratified by pre-treatment dyslipidemia. Pre-treatment Dyslipidemia(n=2377) No Pre-treatment Dyslipidemia(n=2779) Hazard Ratio (95% CI) P-Value Hazard Ratio (95% CI) P-Value Hormone Therapy 1.52 (1.19-1.95) <0.001 0.96 (0.71-1.30) 0.81 Type 2 Diabetes 1.34 (1.07-1.70) 0.01 1.18 (0.79-1.76) 0.41 Hypertension 1.68 (1.31-2.15) <0.001 1.43 (1.15-1.78) 0.001 Chronic Kidney Disease 1.96 (1.46-2.62) <0.001 1.45 (0.85-2.47) 0.18 Peripheral Vascular Disease 1.47 (1.02-2.01) 0.04 1.10 (0.54-2.26) 0.79 Age 1.05 (1.03-1.06) <0.001 1.04 (1.03-1.05) <0.001 Statin Usage 0.72 (0.59-0.89) 0.002 0.90 (0.65-1.23) 0.50 Smoking History 1.18 (0.96-1.45) 0.11 1.20 (1.00-1.44) 0.05