Department of Population Health, University of Kansas Medical Center, Kansas City, KS, 66160, USA.
Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, KS, USA.
J Cancer Surviv. 2023 Apr;17(2):351-359. doi: 10.1007/s11764-022-01229-5. Epub 2022 Jul 5.
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.
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.
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).
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.
There is a need to improve clinical strategies for reducing cardiovascular risk and managing pre-existent CVD in prostate cancer survivors.
心血管疾病（CVD）是男性前列腺癌患者死亡的常见原因。然而，前列腺癌幸存者中预防保健的实施和已有 CVD 的管理尚未得到充分研究。
本研究分析了 2011 年至 2013 年间北卡罗来纳州新诊断为局限性前列腺癌的男性的前瞻性队列，这些患者通过医疗保险和私人保险索赔以及退伍军人事务部（VA）的临床数据进行了链接。在无预先存在的 CVD 的患者中，主要结局是年度预防保健（血糖筛查、胆固醇水平检测和≥1 次初级保健提供者就诊）的综合指标。在已有 CVD 的患者中，主要结局是每年进行心脏病专家就诊；也评估了血糖、胆固醇水平检测和初级保健就诊。
我们的样本包括 492 名成功链接到保险索赔和/或 VA 数据的患者，其中 103 名（20.9%）患有预先存在的 CVD。前列腺癌诊断后第一年预防保健的实施率从 52.7%（95%置信区间[CI]，47.7%至 57.6%）下降到第三年的 40.8%（95%CI：33.7%至 48.4%）。在患有预先存在的 CVD 的患者中，只有 23.4%（95%CI：13.6%至 37.2%）在所有 3 年内都看了心脏病专家。黑人男性比白人男性更有可能在第一年看心脏病专家（风险比[RR] = 1.72，95%CI：1.10 至 2.71）。
在基于人群的前列腺癌幸存者队列中，CVD 预防保健的实施随时间推移而下降，预先存在的 CVD 的心脏病专家主导管理的频率较低。
需要改进临床策略，以降低前列腺癌幸存者的心血管风险并管理预先存在的 CVD。
