Yadalam Adithya K, Razavi Alexander C, Patel Sagar A, Liu Chang, Sun Yan V, Mandawat Anant
Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.
Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, USA.
Cardiooncology. 2025 Apr 10;11(1):36. doi: 10.1186/s40959-025-00330-9.
Cardiovascular mortality is a major cause of death in prostate cancer (PCa) survivors, yet tools for cardiovascular risk stratification in this population are lacking. Although hemoglobin A1c (HbA1c) is routinely utilized for risk stratification in the general population, the value of HbA1c for cardiovascular risk stratification in patients with PCa is unknown. Leveraging data from the UK Biobank, we analyzed the association of HbA1c and adverse cardiovascular outcomes in 2,270 men diagnosed with PCa. Over a median follow-up of 13.4 (IQR 1.7) years, 172 cardiovascular death or non-fatal myocardial infarction (MI) events occurred. When compared to participants with an HbA1c < 5.7% in competing-risk regression analysis accounting for non-cardiovascular death, HbA1c ≥ 6.5% was the strongest predictor of cardiovascular death or non-fatal MI (sHR 1.88, 95% CI 1.01-3.48, P < 0.001) after insulin use in a risk model adjusted for demographics, traditional cardiovascular risk factors, and insulin use. Furthermore, when compared to age-matched male UK Biobank participants without PCa, continuous HbA1c levels were a stronger predictor of adverse cardiovascular outcomes in PCa survivors (P-interaction = 0.011). Our findings highlight HbA1c as a robust predictor of cardiovascular risk in men with PCa. Further prospective studies are needed to discern if improving glycemic control could decrease the risk of adverse cardiovascular outcomes in this population.
心血管疾病死亡率是前列腺癌（PCa）幸存者的主要死因，但该人群缺乏心血管风险分层工具。虽然糖化血红蛋白（HbA1c）在普通人群中常用于风险分层，但HbA1c在PCa患者心血管风险分层中的价值尚不清楚。利用英国生物银行的数据，我们分析了2270名被诊断为PCa的男性中HbA1c与不良心血管结局之间的关联。在中位随访13.4（四分位间距1.7）年期间，发生了172例心血管死亡或非致命性心肌梗死（MI）事件。在考虑非心血管死亡的竞争风险回归分析中，与HbA1c<5.7%的参与者相比，在根据人口统计学、传统心血管危险因素和胰岛素使用情况调整的风险模型中，使用胰岛素后，HbA1c≥6.5%是心血管死亡或非致命性MI的最强预测因素（标准化风险比1.88，95%置信区间1.01-3.48，P<0.001）。此外，与年龄匹配的无PCa的英国生物银行男性参与者相比，连续的HbA1c水平是PCa幸存者不良心血管结局的更强预测因素（P交互作用=0.011）。我们的研究结果突出了HbA1c作为PCa男性心血管风险的有力预测指标。需要进一步的前瞻性研究来确定改善血糖控制是否可以降低该人群不良心血管结局的风险。
