Table 3.

Management of prostate cancer patients with established cardiovascular disease

Category	Population	Recommendation
Antithrombotic therapy	MI in past 12 months PCI with DES in past 3–12 months (or BMS in past 1 month)	ASA 81 mg daily AND P2Y12 inhibitor (ticagrelor or clopidogrel)
	All others	ASA 81 mg daily; consider either rivaroxaban 2.5 mg BID or ticagrelor 60 mg BID (or clopidogrel 75 mg daily) for higher risk patients
Lipid-lowering therapy	All	Statin therapy to target a decrease in LDL of ≥50% or LDL <2.0 Additional lipid-lowering therapy if unable to reach target with maximal tolerated statin dose (as per CCS lipid guidelines)
ACE or ARB	All	ACE inhibitor ARB if ACE-intolerant
β blocker	Angina LVEF ≤40%	Target HR 55–60 bpm Metoprolol succinate, bisoprolol, or carvedilol at maximally tolerated HF doses
Anti-hyperglycemic therapy	Diabetes	HbA1C <7% Consider SGLT2 inhibitor or GLP1RA as per DC guidelines
Smoking cessation	All	Benefits of nicotine replacement or pharmacologic therapy outweigh risks in stable patients
Physical activity and dietary modification	All	Consider cardiac rehab referral

ACE: angiotensin-converting enzyme; ARB: angiotensin II receptor blocker; ASA: acetylsalicylic acid; BID: twice daily; BMS: bare metal stents; CCS: Canadian Cardiovascular Society; DES: drug-eluting stents; HF: heart failure; LDL: low-density lipoprotein; LHR: heart rate; LVEF: left ventricular ejection fraction; MI: myocardial infarction; PCI: percutaneous coronary intervention.