Androgen deprivation therapy

Cardio-oncological evaluation* in very high and high risk patients**

before cancer treatment

Therapeutic optimization of cardiovascular risk factors and diseases

ABCDE program***

Hypertension

ACEi****

Dyslipidemia

Statins*****

Diabetes

Diabetologist visit

Cardio-oncological evaluation*

every 3-6 months

*A cardio-oncological evaluation will systematically include at least one visit with blood pressure, blood glucose, lipid profile, SCORE risk (ESC), GFR calculation, ECG and TTE. Measurements of global longitudinal strain and 3D FeVG (if feasible) are recommended with the same machine.

 

**Refer to the ESC or ACC/AHA risk categories (previous CV diseases + risk factors).

 

***see below.

 

****In some studies, ACE inhibitors might reduce the overall risk of mortality from prostate cancer. 

 

*****In some studies, statins might lower circulating testosterone levels. 

Adapted from Bhatha et al, Circulation. 2016;133:537-541

ABCDE program

A: Awareness and Aspirin (if indicated) -Increased awareness of patients of cardiovascular signs and symptoms 

 

B: Blood pressure

Goal blood pressure <140/90 mmHg 

 

C: Cholesterol and Cigarettes

High-intensity statin therapy for preexisting CVD or hyperlipidemia - Smoking cessation counseling, therapy  

 

D: Diet and Diabetes

Diet rich in fruits, vegetables, and whole grain and low in saturated fat with 600 IU vitamin D daily and adequate calcium (1200 mg/d), avoidance of excessive alcohol 

 

E: Exercise

150 min/wk of moderate-intensity physical activity or 75 min/wk of vigorous exercise 

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Centre Méditerranéen Hospitalo-Universitaire de Cardio-Oncologie

​Hôpital Nord, chemin des Bourrely, 13015 Marseille, France

Aix-Marseille Université

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© 2020 by Franck Thuny