Immediate risk for cardiovascular events and suicide following a prostate cancer diagnosis: prospective cohort study.
BACKGROUND
Stressful life events have been shown to be associated with altered risk of various health consequences. The aim of the present study was to investigate whether the emotional stress evoked by a prostate cancer diagnosis increases the immediate risks of cardiovascular events and suicide.


RESULTS
We conducted a prospective cohort study by following all men in Sweden who were 30 y or older (n = 4,305,358) for a diagnosis of prostate cancer (n = 168,584) and their subsequent occurrence of cardiovascular events and suicide between January 1, 1961 and December 31, 2004. We used Poisson regression models to calculate relative risks (RRs) and 95% confidence intervals (CIs) of cardiovascular events and suicide among men who had prostate cancer diagnosed within 1 y to men without any cancer diagnosis. The risks of cardiovascular events and suicide were elevated during the first year after prostate cancer diagnosis, particularly during the first week. Before 1987, the RR of fatal cardiovascular events was 11.2 (95% CI 10.4-12.1) during the first week and 1.9 (95% CI 1.9-2.0) during the first year after diagnosis. From 1987, the RR for cardiovascular events, nonfatal and fatal combined, was 2.8 (95% CI 2.5-3.2) during the first week and 1.3 (95% CI 1.3-1.3) during the first year after diagnosis. While the RR of cardiovascular events declined, the RR of suicide was stable over the entire study period: 8.4 (95% CI 1.9-22.7) during the first week and 2.6 (95% CI 2.1-3.0) during the first year after diagnosis. Men 54 y or younger at cancer diagnosis demonstrated the highest RRs of both cardiovascular events and suicide. A limitation of the present study is the lack of tumor stage data, which precluded possibilities of investigating the potential impact of the disease severity on the relationship between a recent diagnosis of prostate cancer and the risks of cardiovascular events and suicide. In addition, we cannot exclude residual confounding as a possible explanation.


CONCLUSIONS
Men newly diagnosed with prostate cancer are at increased risks for cardiovascular events and suicide. Future studies with detailed disease characteristic data are warranted.
Fall
Katja
K
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. kfall@hsph.harvard.edu
Fang
Fang
F
Mucci
Lorelei A
LA
Ye
Weimin
W
Andrén
Ove
O
Johansson
Jan-Erik
JE
Andersson
Swen-Olof
SO
Sparén
Pär
P
Klein
Georg
G
Stampfer
Meir
M
Adami
Hans-Olov
HO
Valdimarsdóttir
Unnur
U
D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000523:psychology; D015331:Cohort Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016012:Poisson Distribution; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000523:psychology*; D012044:Regression Analysis; D013315:Stress, Psychological / Q000150:complications*; D013405:Suicide / Q000706:statistics & numerical data*
D017430:Prostate-Specific Antigen