Prevalence of cardiovascular risk factors in long-term survivors of childhood cancer

Cardiovascular disease (CVD), which includes cardiomyopathy/heart failure, coronary artery disease, stroke, pericardial disease, arrhythmias, and valvular and vascular dysfunction, is a major concern for long-term survivors of childhood cancer. There is clear evidence of increased risk of CVD largely attributable to treatment exposures at a young age, most notably anthracycline chemotherapy and chest-directed radiation therapy, and compounded by traditional cardiovascular risk factors accrued during decades after treatment exposure. Preclinical studies are limited; thus, it is a high priority to understand the pathophysiology of CVD as a result of anticancer treatments, taking into consideration the growing and developing heart. Recently developed personalized risk prediction models can provide decision support before initiation of anticancer therapy or facilitate implementation of screening strategies in at-risk survivors of cancer. Although consensus-based screening guidelines exist for the application of blood and imaging biomarkers of CVD, the most appropriate timing and frequency of these measures in survivors of childhood cancer are not yet fully elucidated. Longitudinal studies are needed to characterize the prognostic importance of subclinical markers of cardiovascular injury on long-term CVD risk. A number of prevention trials across the survivorship spectrum are under way, which include primary prevention (before or during cancer treatment), secondary prevention (after completion of treatment), and integrated approaches to manage modifiable cardiovascular risk factors. Ongoing multidisciplinary collaborations between the oncology, cardiology, primary care, and other subspecialty communities are essential to reduce therapeutic exposures and improve surveillance, prevention, and treatment of CVD in this high-risk population.

Download Full-text

Screening for cardiac dysfunction and cardiovascular risk factors in childhood cancer survivors using the Children's Oncology Group (COG) Long-term Follow-up (LTFU) Guidelines.

Journal of Clinical Oncology ◽

10.1200/jco.2010.28.15_suppl.9034 ◽

2010 ◽

Vol 28 (15_suppl) ◽

pp. 9034-9034

Author(s):

S. Armenian ◽

W. Landier ◽

C. Sun ◽

J. Lee ◽

M. Zomorodi ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

Childhood Cancer ◽

Cardiovascular Risk Factors ◽

Cardiac Dysfunction ◽

Childhood Cancer Survivors ◽

Oncology Group ◽

Long Term Follow Up

Download Full-text

Disparities in cardiovascular risk factors by race/ethnicity among adult survivors of childhood cancer: A report from the Childhood Cancer Survivorship Study (CCSS).

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.10017 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 10017-10017

Author(s):

David H Noyd ◽

Yutaka Yasui ◽

Nan Li ◽

Eric Jessen Chow ◽

Smita Bhatia ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

Childhood Cancer ◽

Cardiovascular Risk Factors ◽

Adult Survivors ◽

Childhood Cancer Survivors ◽

Sociodemographic Factors ◽

Race Ethnicity ◽

Rate Ratios ◽

Survivors Of Childhood Cancer

10017 Background: Racial, ethnic, and socioeconomic disparities are documented in outcomes for childhood cancer survivors. Understanding whether childhood cancer modifies established disparities in cardiovascular risk factors (CVRFs) in the general population would inform strategies to reduce health inequities among survivors. Methods: The CCSS is a retrospectively constructed cohort with prospective follow-up consisting of 25,579 five year survivors of childhood cancer diagnosed between 1970 and 1999. We estimated the incidence of self-reported Common Terminology Criteria for Adverse Events (CTCAE) grade >2 CVRFs (hypertension, diabetes, dyslipidemia, and obesity) and multiple (>2) CVRFs among survivors. Multivariable Poisson regression estimated the rate ratios (RR) of CVRFs by race/ethnicity, adjusted for key treatment exposures and sociodemographics. Results: Within the CCSS cohort, there were 20,416 non-Hispanic White (NHW), 1625 non-Hispanic Black (NHB), and 2043 Hispanic survivors with the cumulative incidence estimates of each CVRF at age 40 displayed in Table. Survivors who self-reported “Other” or mixed race were excluded for this analysis (n=1495). NHB survivors were more likely to report hypertension (unadjusted RR 1.3; 95% Confidence Interval [CI] 1.0-1.6), diabetes (RR 1.6; 95% CI 1.0-2.4), obesity (RR 1.6; 95% CI 1.4-1.9), and multiple CVRF (RR 1.3; 95% CI 1.2-1.5), whereas Hispanic survivors were more likely to report diabetes (RR 1.7; 95% CI 1.2-2.4), obesity (RR 1.4; 95% CI 1.2-1.5), and multiple CVRFs (RR 1.1; 95% CI 1.0-1.3) compared with NHW survivors. These observed disparities in risks of CVRFs remained nearly unchanged even after adjustment for sociodemographic factors (age, sex, household income, education, marital status, employment, and insurance) and treatment exposures (Yes/No for anthracyclines, alkylators, and chest radiation). Conclusions: NHB and Hispanic adult survivors demonstrate a higher burden of CVRF compared with NHW survivors, particularly diabetes and obesity. The associated morbidity of these conditions and established increase they incur in risk of more severe cardiovascular disease emphasizes the need for interventions to mitigate CVRFs to promote health equity among these survivors.[Table: see text]

Download Full-text

Treatment-related differences in cardiovascular risk factors in long-term survivors of testicular cancer

Journal of Cancer Survivorship ◽

10.1007/s11764-007-0012-3 ◽

2007 ◽

Vol 1 (1) ◽

pp. 8-16 ◽

Cited By ~ 38

Author(s):

T. Wethal ◽

J. Kjekshus ◽

J. Røislien ◽

T. Ueland ◽

A. K. Andreassen ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

Testicular Cancer ◽

Cardiovascular Risk Factors ◽

Long Term Survivors

Download Full-text

Incidence of and Risk Factors for Histologically Confirmed Solid Benign Tumors Among Long-term Survivors of Childhood Cancer

JAMA Oncology ◽

10.1001/jamaoncol.2018.6862 ◽

2019 ◽

Vol 5 (5) ◽

pp. 671 ◽

Cited By ~ 1

Author(s):

Judith L. Kok ◽

Jop C. Teepen ◽

Helena J. van der Pal ◽

Flora E. van Leeuwen ◽

Wim J. E. Tissing ◽

...

Keyword(s):

Risk Factors ◽

Childhood Cancer ◽

Benign Tumors ◽

Survivors Of Childhood Cancer ◽

Long Term Survivors

Download Full-text

Endothelial Damage in Long-Term Survivors of Childhood Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2012.46.6086 ◽

2013 ◽

Vol 31 (31) ◽

pp. 3906-3913 ◽

Cited By ~ 28

Author(s):

Cornelia A.J. Brouwer ◽

Aleida Postma ◽

H. Louise H. Hooimeijer ◽

Andries J. Smit ◽

Judith M. Vonk ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

Childhood Cancer ◽

Cardiovascular Risk Factors ◽

Plasminogen Activator ◽

Endothelial Damage ◽

Vascular Damage ◽

Tissue Type ◽

Anticancer Treatment

Purpose To evaluate the presence of vascular damage in long-term childhood cancer survivors (CCS) and sibling controls, and to evaluate the association between vascular damage parameters and cancer treatment and influence of cardiovascular risk factors. Patients and Methods Vascular assessment was performed in 277 adult CCSs (median age at diagnosis, 9 years; range, 0 to 20 years; median current age, 28 years; range, 18 to 48 years) treated with potentially cardiovascular toxic anticancer treatment (ie, anthracyclines, platinum, and/or radiotherapy [RT]). Measurements included carotid- and femoral-wall intima-media thickness (IMT), flow-mediated vasodilatation of the brachial artery by ultrasound, assessment of endothelial and inflammatory marker proteins (including tissue-type plasminogen activator [t-PA], plasminogen activator inhibitor type 1 [PAI-I]), and cardiovascular risk factors. CCS assessments were compared with those of 130 sibling controls (median age, 26 years; range, 18 to 51 years). Results At a median of 18 years (range, 5 to 31 years) after treatment, carotid and femoral IMTs in CCSs were not different from those of controls. However, CCSs who received RT as part of their treatment regimen had increased carotid and femoral IMTs and higher t-PA and PAI-I levels, indicating vascular damage and persistent endothelial activation. Patients treated with RT to the neck or chest also had greater femoral IMT. Greater IMT was associated with presence of cardiovascular risk factors (eg, hypertension and overweight). Conclusion After potentially cardiovascular toxic anticancer treatment, CCSs who received RT showed signs of endothelial damage and an unfavorable cardiovascular risk profile compared with controls. CCSs treated with localized RT had increased IMT outside the primary irradiation field. These abnormalities are probably involved in the pathogenesis of cardiovascular morbidity in CCSs.

Download Full-text