Specialist Referral for Cardiovascular Risk in Patients With Prostate Cancer: A Randomized Clinical Trial.

In 30 seconds

This multicenter randomized clinical trial tested whether routine cardiovascular-specialist referral improved risk-factor control and cardiovascular outcomes in patients with prostate cancer who were starting or had recently started androgen deprivation therapy, or had a recent diagnosis. Among 2487 patients followed for a median of 5.8 years, the hierarchical composite favored referral (win ratio, 1.60; 95% CI, 1.42-1.81), largely because cholesterol was lower with greater protocol-mandated statin use. The trial found no difference in time to cardiovascular death, myocardial infarction, stroke, or heart failure between groups.

Key findings

• The hierarchical composite favored specialist referral, with a win ratio of 1.60 (95% CI, 1.42-1.81), mainly reflecting improved cholesterol control.
• Mean cholesterol was 12 mg/dL lower in the intervention group (95% CI, 9-15 mg/dL), associated with greater protocol-mandated statin use.
• There was no difference in time to cardiovascular death, myocardial infarction, stroke, or heart failure (subdistribution hazard ratio, 1.08; 95% CI, 0.79-1.49).
• Mean close-out systolic blood pressure was 131.1 (16.9) mm Hg with referral and 132.9 (18.3) mm Hg with usual care.

Why it matters

Cardiovascular risk factors are common and may be inadequately controlled in patients with prostate cancer. This trial indicates that a structured specialist-referral strategy can improve cholesterol control, but its composite benefit was driven mainly by this risk-factor outcome rather than a demonstrated reduction in major cardiovascular events. The distinction is important when interpreting the clinical significance of the composite result.

What to keep in mind

The trial found no difference in clinical cardiovascular events; whether improved risk-factor control translates into fewer events remains uncertain.