Hormone Therapy Usage Is Associated With Adverse Cardiovascular Events in Prostate Cancer Patients of the All of Us Research Program Cohort.

Background: Hormone therapy (HT) has greatly improved overall survival for prostate cancer patients, but may also influence cardiovascular health in an already high-risk population.

Methods: This retrospective cohort study examined participants in the All of Us Research Program with prostate cancer, had no prior history of adverse cardiovascular events, and were either treated or not treated with HT. HT was defined as GnRH agonists, GnRH antagonists, abiraterone, androgen antagonists, or androgen receptor pathway inhibitors. We defined adverse cardiovascular event as myocardial infarctions, heart failure, or strokes. Time to adverse cardiovascular event was defined using longitudinal electronic health record data. We evaluated whether HT use affected the risk of adverse cardiovascular events using a Cox regression model adjusted for established cardiovascular risk factors.

Results: The final cohort included 5156 participants. After adjustment for cardiovascular risk covariates, HT treatment was associated with increased risk of adverse cardiovascular event (HR: 1.22; 95% CI: 1.01-1.48; p = 0.03). In participants with pre-treatment dyslipidemia, HT usage was associated with increased risk of adverse cardiovascular events (HR: 1.52; 95% CI: 1.19-1.95; p < 0.001). In participants without pre-treatment dyslipidemia, no association was found (HR: 0.96; 95% CI: 0.71-1.30; p = 0.81).

Conclusions: Our results show that HT-associated cardiovascular risk may be synergistically amplified by dyslipidemia. These results suggest that risk stratification by dyslipidemia status may improve cardiovascular outcomes for prostate cancer survivors.