Understanding Cardiovascular Risk in Prostate Cancer: Role of Disparities, Diabetes, and Aging

The primary objective of this review article is to dissect the intricate relationship between disparities, aging, diabetes, and their collective influence on cardiovascular disease (CVD) risk in prostate cancer (PC) patients. We sought to answer how these determinants interact with each other and contribute to the varying CVD outcomes observed in different subsets of PC patients. It has become evident that social determinants of health (SDOH) significantly impact PC outcomes. Particularly, cardiovascular outcomes in non-Hispanic Black (NHB) patients, those from lower socioeconomic backgrounds, and residing in rural areas are notably worse. Diabetes, a growing concern worldwide, has been linked to increased PC-specific and all-cause mortality. Interestingly, recent studies highlight the potential of metformin therapy in enhancing survival rates, especially pivotal for those undergoing androgen deprivation therapy (ADT). Furthermore, the implications of age on PC are profound. The age-driven alterations in factors like allostatic load, responses to ADT, and vascular health play a crucial role in influencing CVD outcomes. Our article highlights the multifaceted factors influencing cardiovascular risk in PC patients. Social disparities, aging, and diabetes mellitus significantly shape CVD outcomes. A holistic approach that targets both systemic and individual concerns, focusing on bridging healthcare access gaps and devising effective diabetes management strategies, is imperative. Metformin therapy emerges as a beacon of hope, especially for those patients on ADT. To improve cardiovascular outcomes in PC patients, there is an urgent need to target modifiable risk factors, emphasizing special attention to vulnerable populations. Further research is still needed to develop targeted interventions to mitigate the risk of disparities while improving cardiovascular outcomes, especially in vulnerable populations.