Supplementary Material for: Prognostic impact of coronary calcifications in patients with recently diagnosed prostate cancer

Background. Patients with prostate cancer are at increased risk of cardiovascular events. A non-electrocardiogram gated CT scan of the thorax is part of the diagnostic workup, allowing for assessment of coronary calcifications. However, the prognostic impact of a coronary artery calcium score (CACS) obtained from such CT scans is uncertain. Objectives. To investigate the association between CACS and a combined endpoint of all-cause death, myocardial infarction, or stroke in patients with recently diagnosed prostate cancer. Methods. The primary analysis included patients (N=571) with recently diagnosed prostate cancer and without known coronary artery disease undergoing prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT). Patients were stratified into four CACS groups. Cox proportional hazard models adjusted for risk factors were used to examine the association between CACS and the combined endpoint. Results. Patients were distributed in the four CACS groups as follows: CACS 0-10 (26%), 11-99 (21%), 100-399 (24%) and ≥400 (29%). An increased risk of the combined endpoint was found with increasing CACS. Compared with CACS 0-10, the hazard ratios for CACS 11-99, 100-399 and ≥400 were 0.95 (95% CI: 0.37-2.42), 2.39 (95% CI: 1.13-5.09) and 3.14 (95% CI: 1.52-6.48), respectively. Only 53% of patients in the CACS ≥400 group received statins. Conclusion. In patients with prostate cancer, assessment of a CACS from the initial PET/CT scan allows for the identification of patients with a threefold higher risk of death, myocardial infarction, or stroke. Initiation of preventive statin treatment in these patients could reduce cardiovascular events.