Abstract Body (Do not enter title and authors here): Introduction

Recent studies have highlighted the cardiotoxic effects of novel androgen deprivation therapy for prostate cancer. The association of demographic and geographic background on cardiovascular disease (CVD)-related mortality in patients with prostate cancer is unclear.

Goals

We aimed to analyze the trends in CVD mortality among patients with prostate cancer in the United States (US) from 1999-2022, with stratification by age, race, census region, rural-urban status, place of death, and specific CVD types.

Methods

The age-adjusted mortality rates (AAMR) per 100,000 people were extracted using the Centers for Disease Control and Prevention WONDER database from 1999-2022. Joinpoint regression was utilized to calculate annual percentage change (APC) with 95% confidence intervals to assess for significant differences in change in AAMR over time.

Results

A total of 440,318 deaths occurred due to CVD in patients with prostate cancer in the US in the last 20 years. The AAMR declined from 1999 to 2016 (APC -3.0 [-3.3, -2.8]) and rose till 2022 (APC 4.6 [3.4, 6.2]). AAMRs were stable in recent years for Non-Hispanic (NH) Asian or Pacific Islanders (2018-2020; APC (11.7 [-0.9, 17.9]) and NH American Indian or Alaska Native men (1999-2022, APC (-0.6 [-1.6, 0.3]). NH Black, NH White, and Hispanic men had a significant increase in AAMR from 2017 (APC 4.9), 2016 (APC 5.1), and 2018 (APC 7.0) to 2022, respectively, after an initial decline. NH Black men had the highest AAMR across all census regions. Mississippi, the District of Columbia, Nebraska, and California had the greatest overall AAMRs. The AAMRs were higher in rural than urban areas (5.9 vs 5.3/100000 people). Most deaths occurred in the decedent's home (35.3%) and in men aged >85 years. Ischemic heart disease (AAMR 2.0), hypertensive disease (AAMR 1.7), and cardiac arrest (AAMR 1.4) were the top 3 causes of CVD-related mortality among patients with prostate cancer.

Conclusion

CVD mortality in prostate cancer patients has increased in recent years with the greatest AAMR in NH Black and elderly men, and those living in rural areas. Identifying the causes and creating policies to reduce disparities requires further research.