Prostate-cancer referrals improved cholesterol without cutting cardiac events
Referral to an internist or cardiologist improved cholesterol in men with prostate cancer. Cardiovascular death, myocardial infarction, stroke and heart failure did not fall. Referred patients received a statin regardless of cholesterol level, a systolic blood pressure target of 130 mm Hg or below, and counselling on smoking, diet and exercise. Calcium scoring versus pooled cohort equations for statin guidance left major cardiovascular events at 2.7 per cent in both groups, while people advised from a calcium score stayed on the drug far more often.
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Referral improved cholesterol and left cardiac events unchanged
In men with prostate cancer, referral to an internist or cardiologist improved risk factor management and did not reduce cardiovascular death, myocardial infarction, stroke or heart failure. Darryl Leong and colleagues report that referral improved cholesterol and other risk-factor care while major cardiovascular events stayed without a difference between the groups. The authors list as limitations a lower-than-expected event rate, crossover to specialist care from usual care, possible differential ascertainment of outcomes in a pragmatic design, and an overrepresented White population.[1]
The path included a statin and a 130 mm Hg systolic target
People referred to a specialist received a statin regardless of cholesterol level, a systolic blood pressure target of 130 mm Hg or below, smoking-cessation counselling and diet and exercise advice. Mean age was 68. The comparison ran at 55 sites in eight countries. Over a median 5.8 years there was no difference between the groups in cardiovascular death, myocardial infarction, stroke or heart failure.[1]
Calcium scoring and risk equations left events at 2.7 per cent
Statin guidance based on a coronary artery calcium score was set against the pooled cohort equations in people with no known atherosclerotic disease, no diabetes and no prior statin use. Major cardiovascular events stayed at 2.7 per cent in both groups. The equations group received a statin recommendation more than three times as often as the calcium group, yet patients advised on the basis of a calcium score stuck with the drug far more, 62 per cent against 23 per cent. Mean age was 64 and 51 per cent were women. Joseph B Muhlestein of Intermountain Medical Center said lower-than-expected event rates reduced the study's power to detect a difference and that equivalence between the groups was not demonstrated. The 2025 focused update to the ESC and EAS dyslipidaemia guidelines already recommends that a raised calcium score, where measured, be considered a risk modifier in people at moderate risk or near treatment thresholds.[2]
