Development of cardiovascular disease risk factors in patients with prostate cancer initiating novel hormonal therapies (NHTs): Real world evidence.

Abstract

146 Background: Novel hormonal therapies (NHTs), abiraterone acetate, enzalutamide, apalutamide, and darolutamide, target the androgen receptor axis and have become the standard of care for patients with advanced prostate cancer. Although NHTs have a generally tolerable side effect profile, cardiovascular system toxicities are a known and under-researched treatment-related adverse event, with limited real-world data available. Methods: A retrospective cohort study was conducted among patients with advanced prostate cancer, who initiated an NHT between January 2022 and August 2025 at our academic center. The study assessed the incidence of initiating new antihypertensive, lipid-lowering, or antidiabetic medications following NHT initiation. Results: Baseline characteristics are summarized in Table 1. 195 patients were included in this study. 87/195 (44.6%) of patients were on abiraterone acetate, 11/195 (5.6%) on apalutamide, 80/195 (41.0%) on darolutamide, and 17/195 (8.7%) on enzalutamide. Incidence of initiation of a new anti-hypertensive medication after NHT start was 20/87 (30.0%) of patients in the abiraterone acetate group, 2/11 (18.2%) in the apalutamide group, 13/80 (16.3%) in the darolutamide group, and 2/17 (11.8%) in the enzalutamide group. Incidence of initiation of a new lipid-lowering medication after NHT start was 16/87 (18.4%) of patients in the abiraterone acetate group, 2/11 (18.2%) in the apalutamide group, 8/80 (10.0%) in the darolutamide group, and 2/17 (11.8%) in the enzalutamide group. Incidence of initiation of a new diabetes medication after NHT start 19/87 (21.8%) of patients in the abiraterone acetate group, 1/11 (9.1%) in the apalutamide group, 17/80 (21.3%) in the darolutamide group, and 2/17 (11.8%) in the enzalutamide group. Conclusions: Although baseline characteristics of hypertension, hyperlipidemia and diabetes mellitus were roughly comparable the abiraterone acetate and darolutamide groups, patients initiating abiraterone acetate demonstrated higher rates of initiation of antihypertensive and lipid-lowering medications compared to those receiving darolutamide. However, the need for initiation of new diabetes medication was comparable between these two groups. Baseline prevalence of hypertension (HTN), hyperlipidemia (HLD) and diabetes mellitus (DM) per NHT group. HTN HLD DM Abiraterone acetate 54/87 (62.1%) 43/87 (49.4%) 22/87 (25.3%) Apalutamide 7/11 (63.6%) 5/11 (45.5%) 5/11 (45.5%) Darolutamide 46/80 (57.5%) 43/80 (53.8%) 23/80 (28.9%) Enzalutamide 9/17 (52.9%) 11/17 (64.7%) 8/17 (47.1%)