A set of uncontrolled, modifiable cardiovascular risk factors may help identify a subgroup of patients with prostate cancer who could benefit from additional cardiovascular care, according to findings published in JACC: CardioOncology and presented at the ESC Congress 2026.
“The major findings from this stratified analysis of a large, pragmatic, international, randomized controlled trial of a structured cardiovascular intervention for patients with prostate cancer are that more favorable intervention estimates were observed among participants with total cholesterol >4 mmol/L, self-reported hypertension or elevated baseline BP (systolic BP ≥130 mm Hg or diastolic BP ≥80 mm Hg), and possibly diabetes,” said Cristina Cano Garcia, MD, and Jehonathan Pinthus, MD, PhD, et al.
RADICAL PC-2: Background and Study Methods
Researchers aimed to identify subgroups of patients with prostate cancer that are more likely to benefit from a referral for routine cardiovascular care.
The RADICAL PC-2 (RAndomizeD Intervention for CArdiovascular and Lifestyle Risk Factors in Prostate Cancer Patients) study was a pragmatic, randomized controlled trial looking at whether referral to a cardiologist or internist due to cardiovascular risk factors could improve outcomes for patients with newly diagnosed prostate cancer or those who were starting androgen-deprivation therapy for the first time (n = 2,487).
In the interventional group, patients were referred to a cardiologist or internist for statin therapy, blood pressure monitoring, lifestyle modification advice, smoking cessation, and more.
The study looked at composite clinical outcomes including cardiovascular death, myocardial infarction, stroke, heart failure, suboptimal cholesterol, and systolic blood pressure control. The secondary outcome measure was time to cardiovascular death, myocardial infarction, stroke, or heart failure.
Follow-up was conducted at 3, 6, 12, 18, and 24 months, as well as annually thereafter through the end of the study.
Key Findings
The impact of treatment differed by patients' baseline total cholesterol level of ≤4 mmol/L vs >4 mmol/L (interaction P = .016).
Additionally, treatment impact differed by baseline blood pressure status of systolic blood pressure ≥130 mm Hg or diastolic ≥80 mm Hg vs <130/80 mm Hg; interaction P = .003). In patients with a systolic blood pressure ≥130 mm Hg or diastolic ≥80 mm Hg, the subdistribution hazard ratio (sHR) was 0.86 (95% confidence interval [CI] = 0.61–1.21), and 4.85 (95% CI = 1.65–14.26) for those with a blood pressure <130/80 mm Hg.
In a subgroup of patients with diabetes, the interaction P-value did not reach statistical significance, although there was a numerical difference with sHRs of 0.53 (95% CI = 0.24–1.15) for patients with diabetes and 1.25 (95% CI = 0.88–1.78) for those without.
“This important international study works to establish an evidence base of who benefits and how they may benefit from cardiovascular and internist management of risk,” added Bonnie Ky, MD, MSCE, FACC, Editor-in-Chief of JACC: CardioOncology.
DISCLOSURES: For full disclosures of the study authors, visit jacc.org.
