Abstract 4366860: Hormonal Therapy and the Risk of Cardiovascular Diseases Among Men with Prostate Cancer

Background: Hormonal therapy (HT) is a cornerstone of prostate cancer treatment; however, its potential cardiovascular risks remain a clinical concern. This study evaluated the incidence of cardiovascular events among prostate cancer patients treated with HT compared to those managed with prostatectomy or radiation alone. Research Questions: We hypothesized that hormonal therapy in men with prostate cancer would be associated with an increased risk of major cardiovascular events at 1, 2, and 3 years of follow-up compared to those not receiving hormonal therapy. Methods: A retrospective cohort study was conducted using TriNetX. Male patients aged ≥50 years diagnosed with prostate cancer between 2010 and 2024 were included. Patients were stratified by receipt of HT versus no HT (prostatectomy or radiation only). Propensity score matching (1:1) was used to balance demographics and comorbidities. Outcomes included acute myocardial infarction, cerebral infarction, cardiomyopathy, heart failure, atrial fibrillation, and chronic ischemic heart disease. Kaplan-Meier survival analysis and Cox proportional hazards models estimated 1-, 2-, and 3-year risks. Results: After matching (n = 46,947 per group), HT was associated with increased risks of myocardial infarction (HR 1.54), cerebral infarction (HR 1.52), cardiomyopathy (HR 1.60), and heart failure (HR 1.57) at Year 1 (all p < 0.001). These associations persisted through Years 2 and 3 (HRs 1.43–1.54). Chronic ischemic heart disease showed modest but significant risk at Years 2 and 3. No significant differences were observed for atrial fibrillation. Kaplan-Meier curves showed lower event-free survival with HT across significant outcomes. Conclusions: HT in prostate cancer is associated with sustained increased cardiovascular risks over 3 years. These findings highlight the need for long-term cardiovascular monitoring and incorporation of preventive strategies in shared treatment planning.