Adverse Cardiovascular Outcomes of Individuals Treated With Androgen Deprivation Therapy.

Introduction: Cardiovascular management of patients who receive androgen deprivation therapy (ADT) is evolving as new medications and practice patterns emerge. We sought to identify factors associated with treatment onset major adverse cardiovascular events (MACE) among patients undergoing ADT.

Methods: This was a retrospective cohort of patients at a multicenter academic institution prescribed pharmacologic ADT from January 2018 to March 2024. Patients using leuprolide or degarelix were stratified into pre-relugolix (January 2018-November 2020) and post-relugolix (December 2020-March 2024) eras. MACE was defined as myocardial infarction, stroke, or cardiovascular-associated death.

Results: One thousand one hundred twenty-eight and 1398 patients were prescribed leuprolide pre-relugolix and post-relugolix, respectively. Eighty patients were prescribed degarelix, and 367 patients were prescribed relugolix. The incidence of treatment onset MACE in the pre-relugolix era was 5.4% and 8.3% for leuprolide and degarelix, respectively. Incidence in the post-relugolix era was 2.3%, 3.6%, and 2.1% for leuprolide, degarelix, and relugolix, respectively. Higher Charlson Comorbidity Index (HR = 1.12, CI = 1.06-1.18, P < .001) and prior MACE (HR = 5.32, CI = 3.36-8.42, P < .001) were associated with increased risk of treatment onset MACE. While patients with a history of previous MACE were more likely to be managed by cardiology while receiving ADT (55% vs 23%, P < .001), 27% lacked care from cardiology or primary care during therapy and received cardioprotective therapies.

Conclusions: A history of heart attack or stroke is significantly associated with increased risk of MACE after initiating ADT. Relugolix was not associated with lower risk of MACE in our analysis. Strategies to optimize the cardiovascular management of patients receiving ADT are needed.