ROUTINE cardiovascular specialist referral improved cardiovascular risk in patients with prostate cancer, primarily through better cholesterol control, according to a randomised clinical trial of 2,487 patients.
The study included patients from 55 sites across eight countries between 2015 and 2025. Participants had been diagnosed with prostate cancer within the previous 12 months, had recently started androgen deprivation therapy (ADT), or were due to begin ADT.
Patients were randomly assigned to usual care alone or usual care alongside referral to an internist or cardiologist. The specialist intervention included a target systolic blood pressure of ≤130 mmHg, statin treatment regardless of cholesterol levels, smoking cessation support, and dietary and exercise advice.
After a median follow-up of 5.8 years, the intervention group had a more favourable hierarchical composite outcome than the usual care group (win ratio: 1.60; 95% CI: 1.42–1.81).
However, this difference was largely attributable to cholesterol control rather than reductions in cardiovascular events. Mean cholesterol was 12 mg/dL lower among patients receiving specialist care, which the researchers attributed to greater protocol-mandated statin use.
The difference in blood pressure was smaller. Mean systolic blood pressure at study close-out was 131.1 mmHg in the intervention group compared with 132.9 mmHg in the usual care group.
Despite improvements in cardiovascular risk factors, the data did not demonstrate a reduction in cardiovascular death, myocardial infarction, stroke, or heart failure (subdistribution hazard ratio (HR): 1.08; 95% CI: 0.79–1.49).
The findings indicate that cardiovascular risk in prostate cancer can be addressed through systematic management of modifiable risk factors, particularly cholesterol.
The study did not establish that routine cardiovascular specialist referral prevents cardiovascular events. The researchers therefore highlighted uncertainty about whether improved risk-factor management would translate into better long-term cardiovascular outcomes.
For clinicians managing patients with prostate cancer, particularly those receiving ADT, the findings reinforce the importance of identifying and addressing cardiovascular risk factors. However, the results do not demonstrate that all patients with prostate cancer require specialist cardiovascular referral.
Further research will be needed to determine whether the improvements in risk-factor control observed with specialist involvement can ultimately reduce cardiovascular morbidity and mortality.
Leong DP et al. Specialist referral for cardiovascular risk in patients with prostate cancer: a randomized clinical trial. JAMA Intern Med. 2026;DOI: 10.1001/jamainternmed.2026.4773.
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