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Cardiovascular disease prevention and management of pre-existent cardiovascular disease in a cohort of prostate cancer survivors

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Abstract

Purpose

Cardiovascular disease (CVD) is a common cause of mortality among men with prostate cancer. However, receipt of preventive care and management of pre-existent CVD has not been well studied in prostate cancer survivors.

Methods

This study examined a prospective cohort of men newly diagnosed with localized prostate cancer between 2011 and 2013 throughout North Carolina linked to Medicare and private insurance claims and clinical data from the Veterans Affairs (VA). In patients without pre-existent CVD, the primary outcome was a composite measure of annual preventive care (blood glucose screening, cholesterol level testing, and ≥ 1 primary care provider visit). In patients with pre-existent CVD, the primary outcome was annual cardiologist visit; blood glucose, cholesterol level testing, and primary care visits were also assessed.

Results

Our sample comprised 492 patients successfully linked to insurance claims and/or VA data, among whom 103 (20.9%) had pre-existent CVD. Receipt of preventive care declined from 52.7% (95% confidence interval [CI], 47.7 to 57.6%) during the first year after prostate cancer diagnosis to 40.8% (95% CI: 33.7 to 48.4%) during the third year. Among patients with pre-existent CVD, only 23.4% (95% CI: 13.6 to 37.2%) visited a cardiologist in all 3 years. Black men were more likely than White men to visit a cardiologist the first year (risk ratio [RR] = 1.72, 95% CI: 1.10 to 2.71).

Conclusion

In a population-based cohort of prostate cancer survivors, receipt of CVD preventive care declined over time, and frequency of cardiologist-led management of pre-existent CVD was low.

Implications for Cancer Survivors

There is a need to improve clinical strategies for reducing cardiovascular risk and managing pre-existent CVD in prostate cancer survivors.

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Data availability

Data underlying this study are not available to other researchers due to policies of the data providers regarding data access and sharing.

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Acknowledgements

We thank the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) at the Durham Veterans Affairs Health Care System for their support.

Funding

This work was supported by the National Institute On Minority Health And Health Disparities of the National Institutes of Health (R21MD012465) and the Agency for Healthcare Research and Quality, US Department of Health and Human Services as part of the Developing Evidence to Inform Decisions about Effectiveness (DEcIDE) program (contract HHSA29020050040I). Work on this study was supported by the Cancer Information and Population Health Resource, UNC Lineberger Comprehensive Cancer Center, with funding provided by the University Cancer Research Fund via the state of North Carolina. The funders had no role in the design of the study; the collection, analysis, and interpretation of the data; the writing of the manuscript; and the decision to submit the manuscript for publication.

Author information

Authors and Affiliations

  1. Department of Population Health, University of Kansas Medical Center, Kansas City, KS, 66160, USA

    Aaron J. Katz

  2. Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, KS, USA

    Ronald C. Chen

  3. Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Deborah S. Usinger

  4. Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA

    Susanne M. Danus & Leah L. Zullig

  5. Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA

    Leah L. Zullig

Authors
  1. Aaron J. Katz
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  2. Ronald C. Chen
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Contributions

AK: data curation, formal analysis, investigation, methodology, visualization, writing, reviewing, and editing; RC: conceptualization, funding acquisition, methodology, supervision, writing, reviewing, and editing; DU: data curation, project administration; SD: data curation, project administration; LZ: conceptualization, funding acquisition, methodology, supervision, writing, reviewing, and editing.

Corresponding author

Correspondence to Aaron J. Katz.

Ethics declarations

Ethics approval

This is an observational study of existing data. The study received expedited review and approval by the Institutional Review Board of the University of North Carolina at Chapel Hill and the Institutional Review Board of the Durham Veterans Affairs Medical Center.

Conflict of interest

AJK reported receiving personal fees from Kite Pharma and Atara Biotherapeutics outside the submitted work. RCC reported receiving personal fees from AbbVie, Accuray, Bayer, Blue Earth Diagnostics, and Myovant outside the submitted work. The remaining authors have no potential conflicts of interest to disclose.

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The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health, the Agency for Healthcare Research and Quality, Duke University, the U.S. Department of Veterans Affairs, or the U.S. government.

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Cite this article

Katz, A.J., Chen, R.C., Usinger, D.S. et al. Cardiovascular disease prevention and management of pre-existent cardiovascular disease in a cohort of prostate cancer survivors. J Cancer Surviv 17, 351–359 (2023). https://doi.org/10.1007/s11764-022-01229-5

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  • DOI: https://doi.org/10.1007/s11764-022-01229-5

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