Comprehensive care for cardiometabolic health
Why is cardiometabolic health important in ADT management?
ADT is associated with cardiometabolic comorbidities, and cardiovascular (CV) risk factors are common in men with prostate cancer.1-3
CV disease is the leading cause of death in men with prostate cancer other than the cancer itself4
Recommendations for healthcare providers managing cardiometabolic health during ADT
- Perform baseline cardiometabolic assessment5
- Assess the patient’s family history, blood pressure, eGFR, and glucose levels (fasting and nonfasting), and order a lipid panel
- Consider performing a 10-year ASCVD risk assessment
- Counsel patients on the cardiometabolic risk of ADT5
- Explain the risks of ADT, including blood glucose issues, increased LDL cholesterol, high blood pressure, and other CV diseases
- Encourage patients to take control of their health by maintaining a healthy weight and choosing a healthy lifestyle through diet and exercise
- Take a stratified approach to CV risk mitigation5:
Borderline
Any of the following:
- No uncontrolled dyslipidemia, hypertension, diabetes, or metabolic syndrome
- No obesity
- No other risk-enhancing factors
Provide counseling on CV risk, importance of maintaining follow-up with primary care, and healthy lifestyle interventions, including physical activity, nutritional interventions, and weight maintenance.
Intermediate
1-2 of the following:
- Uncontrolled diabetes
- Uncontrolled dyslipidemia
- Uncontrolled hypertension
- Metabolic syndrome
- Obesity
- Current smoker
- Any other risk-enhancing factor
In addition to counseling, initiate or refer for treatment of uncontrolled risk factors. Consider ordering or referring for coronary artery calcium testing.
High
≥2 intermediate risk factors or any of the following:
- Pre-existing ASCVD, heart failure, valvular disease, arrhythmia, or angina
- History of myocardial infarction or stroke
In addition to counseling and management of uncontrolled risk factors, consider referral to cardiology or cardio-oncology.
- Consider statins for primary prevention in patients receiving ADT, regardless of cardiometabolic risk6
- For patients on ADT, statins provide a 27% reduction in risk of overall mortality and a 35% reduction in risk of prostate cancer–specific mortality
- For patients reluctant to initiate statin therapy, consider coronary artery calcium scanning
- Ensure ongoing cardiometabolic monitoring is performed5
- Routinely check blood pressure, eGFR, and glucose levels, and order a lipid panel
Be prepared for CV risks and their potential effects on patients during ADT
