P0278CARDIOVASCULAR RISK FACTORS AND THE LONG TERM OUTCOME OF LUPUS NEPHRITIS

Abstract Background and Aims Systemic Lupus Erythematosus (SLE) is associated with an increased risk of cardiovascular morbidity and cardiovascular mortality. The risk of cardiovascular events is 1.3–2.7 times higher in SLE patients than in the general population, and even higher in patients with lupus nephritis (LN). Traditional risk factors as well as SLE-specific and treatment-related factors all contribute to the increased risk of cardiovascular disease. The primary aim of the present study was to evaluate cardiovascular risk factors, morbidity and mortality in patients with LN. Method This is a retrospective study of patients over the age of 16, with LN proved by kidney biopsy and followed up in our department over a period of 17 years. The diagnosis of lupus was made according to criteria of The American College of Rheumatology revised in 1997. Demographic, clinical and para-clinical data were collected from medical observations. Results We collected 155 women and 19 men with a sex ratio F / H of 8.2. The mean age at the time of the discovery of LN was 32.6 years [15-45 years]. Overall median follow-up time was 81.2 months. Renal symptomatology was dominated by proteinuria noted in all patients with an average proteinuria at 3.3 g / 24h, associated to a nephrotic syndrome in 68% of patients, hematuria was present in 69% of patients and renal failure was present in half of cases with an average serum creatinine of 110 µmol / l. At the time of diagnosis of LN, hypertension was noted in 48.9% of cases, diabetes in 2.8% of cases and obesity in 57.4% of cases with an index average body mass of 28.5 Kg / m2. Smoking was reported in 17.2% of the cases. The average cholesterol level was 5,5±2,1 mmol/l, the average triglycerid level was 2,5±1,1 mmol/. Antiphospholipid syndrome was found in 14.9% of cases. We performed 243 renal biopsies with 174 initial and 69 iterative biopsies. The histological lesions were polymorphic dominated by LN class IV (54.3%), arteriolosclerosis was observed in 47.7% and lesions of thrombotic microangiopathy in 29.8%. Corticosteroid therapy was prescribed in all patients combined with immunosuppressive therapy in 54.6% of cases. The overall survival of the patients at 10 years was 85%. During follow-up, cardiovascular complications found in our series were mainly strokes (6.3%) and coronary insufficiency (5.2%) and transient ischemic attack (6.9%). After a univariate analysis, the additional cardiovascular risk factors identified in our study were antiphospholipid syndrome (p = 0.01), renal failure (p = 0.01), long-term corticosteroid therapy (p = 0.009), the chronicity of the disease (evolution of lupus> 10 years) (p = 0.014), proliferative forms (p=0.001), arteriolosclerosis (p=0.0002) and lesions of thrombotic microangiopathy (p=0.018). Survival in patients without cardiovascular risk factors was better (96% vs 88%). Conclusion In conclusion, in addition to traditional risk factors SLE patients have several disease related risk factors that explain increase cardiovascular disease. A careful control for this risk factors is essential to continuously improve survival in SLE.

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Long-Term All-Cause Mortality and Its Association with Cardiovascular Risk Factors in Thyroid Cancer Survivors: An Israeli Population-Based Study

10.21203/rs.3.rs-39122/v3 ◽

2020 ◽

Author(s):

Elena Izkhakov ◽

Lital Keinan-Boker ◽

Micha Barchana ◽

Yacov Shacham ◽

Iris Yaish ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Thyroid Cancer ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Cox Regression ◽

Increased Risk ◽

All Cause Mortality

Abstract Background: The global incidence of thyroid cancer (TC) has risen considerably during the last three decades, while prognosis is generally favorable. We assessed the long-term all-cause mortality in TC survivors compared to the general population, and its association with cardiovascular risk factors. Methods: Individuals diagnosed with TC during 2001-2014 (TC group) and age- and sex-matched individuals from the same Israeli healthcare system without thyroid disease or a cancer history (non-TC group) were compared. Cox regression hazard ratios (HRs) and 95% confidence intervals (95%CIs) for all-cause mortality were calculated by exposure status. Results: During a 15-year follow-up (median 8 years), 577 TC survivors out of 5,677 (10.2%) TC patients and 1,235 individuals out of 23,962 (5.2%) non-TC patients died. The TC survivors had an increased risk of all-cause mortality (HR=1.89, 95%CI 1.71-2.10), after adjusting for cardiovascular risk factors already present at follow-up initiation. This increased risk was most pronounced in the 55- to 64-year-old age group (HR=1.49, 95%CI 1.33-1.67). The TC survivors who died by study closure had more hypertension (14.6% vs. 10.3%, P = 0.002), more dyslipidemia (11.4% vs. 7.2%, P < 0.001), and more cardiovascular disease (33.6% vs. 22.3%, P = 0.05) compared to those who died in the non-TC group. Conclusions: This large cohort study showed higher all-cause mortality with a higher prevalence of hypertension, dyslipidemia, and cardiovascular disease among TC survivors compared to matched non-TC individuals. Primary and secondary prevention of cardiovascular risk factors in TC survivors is mandatory.

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Association between Cardiovascular Risk Factors and Long-Term All-Cause Mortality in Thyroid Cancer Survivors: An Israeli Population-Based Study

10.21203/rs.3.rs-39122/v1 ◽

2020 ◽

Author(s):

Elena Izkhakov ◽

Lital Keinan-Boker ◽

Micha Barchana ◽

Yacov Shacham ◽

Iris Yaish ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Thyroid Cancer ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Cox Regression ◽

Increased Risk ◽

All Cause Mortality

Abstract Background: The global incidence of thyroid cancer (TC) has risen considerably during the last three decades, while prognosis is generally favorable. We assessed the association between long-term all-cause mortality and cardiovascular risk factors in TC survivors compared to the general population. Methods: Individuals diagnosed with TC during 2001-2014 (TC group) and age- and sex-matched individuals from the same Israeli healthcare system without thyroid disease or a cancer history (non-TC group) were compared. Cox regression hazard ratios (HRs) and 95% confidence intervals (95%CIs) for all-cause mortality were calculated by exposure status. Results: During a 15-year follow-up (median 8 years), 577 TC survivors out of 5,677 (10.2%) TC patients and 1,235 individuals out of 23,962 (5.2%) non-TC patients died. The TC survivors had an increased risk of all-cause mortality (HR=1.89, 95%CI 1.71-2.10), after adjusting for cardiovascular risk factors already present at follow-up initiation. This increased risk was most pronounced in the 55- to 64-year-old age group (HR=1.49, 95%CI 1.33-1.67). The TC survivors who died by study closure had more hypertension (14.6% vs. 10.3%, P = 0.002), more dyslipidemia (11.4% vs. 7.2%, P < 0.001), and more cardiovascular disease (33.6% vs. 22.3%, P = 0.05) compared to those who died in the non-TC group. Conclusions: This large cohort study showed higher all-cause mortality with a higher prevalence of hypertension, dyslipidemia, and cardiovascular disease among TC survivors compared to matched non-TC individuals. Primary and secondary prevention of cardiovascular risk factors in TC survivors is mandatory.

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Long-Term All-Cause Mortality and Its Association with Cardiovascular Risk Factors in Thyroid Cancer Survivors: An Israeli Population-Based Study

10.21203/rs.3.rs-39122/v2 ◽

2020 ◽

Author(s):

Elena Izkhakov ◽

Lital Keinan-Boker ◽

Micha Barchana ◽

Yacov Shacham ◽

Iris Yaish ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Thyroid Cancer ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Cox Regression ◽

Increased Risk ◽

All Cause Mortality

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Long-term all-cause mortality and its association with cardiovascular risk factors in thyroid cancer survivors: an Israeli population-based study

BMC Cancer ◽

10.1186/s12885-020-07401-3 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Elena Izkhakov ◽

Lital Keinan-Boker ◽

Micha Barchana ◽

Yacov Shacham ◽

Iris Yaish ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Thyroid Cancer ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Cox Regression ◽

Increased Risk ◽

All Cause Mortality

Abstract Background The global incidence of thyroid cancer (TC) has risen considerably during the last three decades, while prognosis is generally favorable. We assessed the long-term all-cause mortality in TC survivors compared to the general population, and its association with cardiovascular risk factors. Methods Individuals diagnosed with TC during 2001–2014 (TC group) and age- and sex-matched individuals from the same Israeli healthcare system without thyroid disease or a cancer history (non-TC group) were compared. Cox regression hazard ratios (HRs) and 95% confidence intervals (95%CIs) for all-cause mortality were calculated by exposure status. Results During a 15-year follow-up (median 8 years), 577 TC survivors out of 5677 (10.2%) TC patients and 1235 individuals out of 23,962 (5.2%) non-TC patients died. The TC survivors had an increased risk of all-cause mortality (HR = 1.89, 95%CI 1.71–2.10), after adjusting for cardiovascular risk factors already present at follow-up initiation. This increased risk was most pronounced in the 55- to 64-year-old age group (HR = 1.49, 95%CI 1.33–1.67). The TC survivors who died by study closure had more hypertension (14.6% vs. 10.3%, P = 0.002), more dyslipidemia (11.4% vs. 7.2%, P < 0.001), and more cardiovascular disease (33.6% vs. 22.3%, P = 0.05) compared to those who died in the non-TC group. Conclusions This large cohort study showed higher all-cause mortality with a higher prevalence of hypertension, dyslipidemia, and cardiovascular disease among TC survivors compared to matched non-TC individuals. Primary and secondary prevention of cardiovascular risk factors in TC survivors is mandatory.

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Cardiovascular Disease in Survivors of Childhood Cancer: Insights Into Epidemiology, Pathophysiology, and Prevention

Journal of Clinical Oncology ◽

10.1200/jco.2017.76.3920 ◽

2018 ◽

Vol 36 (21) ◽

pp. 2135-2144 ◽

Cited By ~ 39

Author(s):

Saro H. Armenian ◽

Gregory T. Armstrong ◽

Gregory Aune ◽

Eric J. Chow ◽

Matthew J. Ehrhardt ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Cardiovascular Risk ◽

Childhood Cancer ◽

Cardiovascular Risk Factors ◽

Imaging Biomarkers ◽

Pericardial Disease ◽

Increased Risk ◽

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.

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Future risk of cardiovascular disease risk factors and events in women after a hypertensive disorder of pregnancy

Heart ◽

10.1136/heartjnl-2018-313453 ◽

2019 ◽

Vol 105 (16) ◽

pp. 1273-1278 ◽

Cited By ~ 19

Author(s):

Laura Benschop ◽

Johannes J Duvekot ◽

Jeanine E Roeters van Lennep

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Cardiovascular Disease ◽

Risk Assessment ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Hypertensive Disorder ◽

Cardiovascular Risk Assessment ◽

Increased Risk

Hypertensive disorders of pregnancy (HDP), such as gestational hypertension and pre-eclampsia, affect up to 10% of all pregnancies. These women have on average a twofold higher risk to develop cardiovascular disease (CVD) later in life as compared with women with normotensive pregnancies. This increased risk might result from an underlying predisposition to CVD, HDP itself or a combination of both. After pregnancy women with HDP show an increased risk of classical cardiovascular risk factors including chronic hypertension, renal dysfunction, dyslipidemia, diabetes and subclinical atherosclerosis. The prevalence and onset of cardiovascular risk factors depends on the severity of the HDP and the coexistence of other pregnancy complications. At present, guidelines addressing postpartum cardiovascular risk assessment for women with HDP show a wide variation in their recommendations. This makes cardiovascular follow-up of women with a previous HDP confusing and non-coherent. Some guidelines advise to initiate cardiovascular follow-up (blood pressure, weight and lifestyle assessment) 6–8 weeks after pregnancy, whereas others recommend to start 6–12 months after pregnancy. Concurrent blood pressure monitoring, lipid and glucose assessment is recommended to be repeated annually to every 5 years until the age of 50 years when women will qualify for cardiovascular risk assessment according to all international cardiovascular prevention guidelines.

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Cardiovascular Risk Factors in Hematopoietic Cell Transplantation (HCT) Survivors: Role in Development of Subsequent Cardiovascular Disease

Blood ◽

10.1182/blood.v118.21.330.330 ◽

2011 ◽

Vol 118 (21) ◽

pp. 330-330

Author(s):

Saro H. Armenian ◽

Can-Lan Sun ◽

Tabitha Shannon ◽

Emily Blum ◽

Liton Francisco ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Cumulative Incidence ◽

Chronic Gvhd ◽

Allogeneic Hct ◽

Increased Risk ◽

History Of

Abstract Abstract 330 Introduction: Advances in transplantation strategies and supportive care have resulted in a growing number of long-term HCT survivors. In the general U.S. population, cardiovascular disease is a leading cause of morbidity and mortality, and cardiovascular risk factors (CVRFs), including diabetes hypertension and dyslipidemia are well-established modifiers of the risk. There is increasing evidence that HCT survivors may be at risk for CVRFs that can potentially result in an increased risk of cardiovascular morbidity. However, there is a paucity of knowledge regarding the magnitude of risk and associated risk factors for CVRFs after HCT, and the role these CVRFs play in the subsequent development of cardiovascular disease such as stroke, myocardial infarction, and congestive heart failure, in long-term survivors of HCT. Methods: A retrospective cohort study design was used to describe the cumulative incidence of CVRFs and cardiovascular disease in 1+year survivors of HCT, taking into consideration the competing risk of death. Cox proportional hazards regression analysis was used to calculate relative risk (RR) estimates and 95% confidence intervals (CI), adjusted for relevant covariates. Definition of CVRFs was per the National Cholesterol Education Program Adult Treatment Panel III criteria. Survivors taking immunosuppressant medication for management of graft vs. host disease (GvHD) at the time of CVRF diagnosis were excluded from the regression analysis. Cardiovascular disease was defined per the American College of Cardiology established case definitions. Results: 2041 consecutive one-year survivors who underwent HCT for hematologic malignancies between 1995 and 2004 at City of Hope were included in the analysis. Median age at HCT was 44.1 years (0.6–78.9); 57.6% were female; 62.5% were non-Hispanic white and 24.5% were Hispanic; 41% underwent allogeneic HCT; 26.5% of allogeneic HCT survivors had a history of chronic GvHD; 49.9% received total body irradiation (TBI). Cardiovascular risk factors: After 12,551 person-years of follow-up, the 10-year cumulative incidence of diabetes, hypertension, and dyslipidemia was 16.8%, 36.1% and 43.5%, respectively; 10-year cumulative incidence for multiple (2+) CVRFs was 29.5%. The cumulative incidence of CVRFs was significantly higher for allogeneic HCT recipients (Table). Multivariate analysis adjusted for gender, race/ethnicity, diagnosis, and conditioning-related exposures, revealed older age at HCT and obesity to be risk factors for all three CVRFs. Allogeneic HCT survivors with a history of chronic GvHD were at highest risk for diabetes (RR=32.4, 95% CI: 16.6–63.2, p<0.01), hypertension (RR=12.0, 95% CI: 5.5–26.1, p<0.01), and dyslipidemia (RR=7.2, 95% CI: 4.2–12.3, p<0.01) when compared to autologous HCT recipients. Cardiovascular disease occurred in 117 individuals, at a median 3.8 years following HCT (range 0.1–13.9). The 10-year cumulative incidence of cardiovascular disease was 7.4%, and was highest among survivors with multiple CVRFs (10.9% vs. 5.9% in those with <2 CVRFs, p=0.02). Furthermore, survivors with multiple CVRFs were at 1.8-fold risk (95% CI: 1.1–3.3, p=0.04) of subsequently developing cardiovascular disease when compared to survivors with <2 CVRFs. Conclusions: Allogeneic HCT survivors are at a substantially increased risk for CVRFs following HCT, and chronic GvHD and/or its treatment are critical modifiers of this risk. Survivors with multiple CVRFs are at highest risk for development of cardiovascular disease following HCT. These findings provide rationale for close monitoring and aggressive interventions for this high-risk population in order to reduce cardiovascular morbidity and mortality. Disclosures: No relevant conflicts of interest to declare.

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Prevalence and Predictors of Delayed Cardiovascular Disease (CVD) Among Survivors of Adults with Hematologic Malignancies

Blood ◽

10.1182/blood.v124.21.857.857 ◽

2014 ◽

Vol 124 (21) ◽

pp. 857-857

Author(s):

Saro Armenian ◽

Lanfang Xu ◽

Can-Lan Sun ◽

Len Farol ◽

Smita Bhatia ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Cardiovascular Risk ◽

Cancer Survivors ◽

Cardiovascular Risk Factors ◽

Cancer Diagnosis ◽

Hematologic Malignancies ◽

Cvd Risk ◽

Increased Risk

Abstract Introduction: Advances in treatment strategies and supportive care have resulted in a growing number of long-term survivors of hematologic malignancies. In the general U.S. population, CVD (heart failure, stroke, myocardial infarction) is a leading cause of morbidity and mortality, and cardiovascular risk factors (CVRFs: diabetes, hypertension and dyslipidemia) are well-established modifiers of CVD risk. Childhood (Circulation 2013 22;128) and young adult (<40y at diagnosis; JNCI2014 21;106) cancer survivors have a substantially increased risk of CVD when compared to the general population; this is largely attributable to exposure to cardiotoxic therapies (anthracyclines, radiation) at a young age. Less is known regarding the magnitude of risk of CVD in individuals with hematologic malignancies diagnosed at age ≥40y, a population that accounts for the largest proportion of new cancer diagnoses in the U.S. and has a high prevalence of CVRFs. The few studies addressing this issue have been limited by small sample size, short (<1y) follow-up, varying definitions of cardiovascular outcomes, and lack of comparison to non-cancer controls. The current study overcomes these limitations. Methods: Using a retrospective cohort study design, 2,993 2+y survivors of non-Hodgkin lymphoma (NHL), lymphocytic leukemia (LL), and multiple myeloma (MM) diagnosed at age ≥40y between 2000 to 2007 and treated at Kaiser Permanent Southern California (KPSC) were included in the study. KPSC is the largest integrated managed care organization in Southern California, with documented 10-year insurance retention rates for cancer survivors exceeding 70% (JAYAO 2013 2:59). A non-cancer comparison group (N=6,272) was constructed by selecting individuals enrolled in KPSC and matched to cancer survivors (1:2) on age at diagnosis, sex, and zip-code. Cumulative incidence of CVD (ICD-9 definition: congestive heart failure, stroke, or myocardial infarction) was calculated, taking into consideration the competing risk of death. Definition of CVRFs (hypertension, diabetes, dyslipidemia) was per the National Cholesterol Education Program Adult Treatment Panel III criteria. Cox proportional hazards regression analysis was used to calculate hazard ratio (HR) estimates and 95% confidence intervals (CI), adjusted for relevant covariates. Results: Median age at cancer diagnosis was 63y (range: 40-96); 53.6% were male; 68% were non-Hispanic white; diagnoses: NHL (N=1,787 [59.7%]), LL (N=705 [23.6%], MM (N=501 [16.7%]). In cancer survivors, median time from cancer diagnosis to end of follow-up was 6.2 years (range: 2-10), representing 12,622 person-years of follow-up. Comparison with non-cancer cohort: The 8y cumulative incidence of CVD was significantly higher for NHL survivors (17% vs. 14%, p<0.01), LL (19% vs. 16%, p=0.02), and MM (21% vs. 11%, p<0.01), when compared to non-cancer subjects (Figures). Multivariable analysis adjusted for age, sex, race/ethnicity and CVRFs revealed a significantly increased risk of CVD across all cancer diagnoses (NHL: HR=1.3, 95%CI, 1.1-1.6; LL: HR=1.3, 95%CI, 1.0-1.6, MM=1.9, 95%CI, 1.5-2.5) when compared to non-cancer subjects; younger (<65y at diagnosis) MM survivors were at highest risk (HR=3.5, 95%CI, 2.2-5.6). Modifiers of CVD risk among cancer survivors: Hypertension and diabetes were independent modifiers of CVD risk. Hypertension was associated with a 1.9-fold (95%CI,1.1-3.3) increased risk of developing CVD in NHL survivors and a 3.1-fold (95%CI, 1.4-6.7) increased risk in MM survivors. Diabetes was associated with increased CVD risk across all diagnoses (NHL: HR=1.7, 95%CI, 1.2-2.4; LL: HR=1.6, 95%CI, 1.0-2.6; MM: HR=1.6, 95%CI, 1.0-2.3). Conclusions: Survivors of adult-onset NHL, LL and MM are at increased risk for developing cardiovascular disease when compared to a matched non-cancer cohort. Cardiovascular risk factors such as hypertension and diabetes are independent modifiers of risk of delayed cardiovascular disease. Taken together these data form the basis for identifying high-risk individuals for targeted surveillance, as well as aggressive management of cardiovascular risk factors. Figure 1 Figure 1. Figure 2 Figure 2. Figure 3 Figure 3. Disclosures No relevant conflicts of interest to declare.

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Cardiovascular Disease in Adolescents and Young Adults with Hematologic Malignancies

Blood ◽

10.1182/blood.v126.23.880.880 ◽

2015 ◽

Vol 126 (23) ◽

pp. 880-880

Author(s):

Chun Chao ◽

Lanfang Xu ◽

Cooper Robert ◽

Smita Bhatia ◽

Saro Armenian

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Cardiovascular Risk ◽

Cancer Survivors ◽

Cardiovascular Risk Factors ◽

Cancer Diagnosis ◽

Hematologic Malignancies ◽

Cvd Risk ◽

Increased Risk

Abstract Introduction: Advances in treatment strategies and supportive care have resulted in a growing number of survivors of adolescents and young adults (AYA: diagnosed 15-39y) with hematologic malignancies. In the general U.S. population, cardiovascular disease (CVD: heart failure, stroke, myocardial infarction) is a leading cause of morbidity and mortality, and cardiovascular risk factors (CVRFs: diabetes, hypertension and dyslipidemia) are well-established modifiers of CVD risk. While considerable effort has been made to characterize long-term CVD outcomes in survivors of childhood (<21y) cancer, there is a paucity of information on the magnitude and modifiers of CVD risk, as well as outcomes after onset of CVD in survivors of AYA cancers. AYAs diagnosed with hematologic malignancies may be at a higher risk of CVD when compared to the general population because of exposure to cardiotoxic therapies (anthracyclines, radiation), and the development of new CVRFs as they age. Methods: Using a retrospective cohort study design, 779 2+y survivors of non-Hodgkin lymphoma (NHL: N=274), Hodgkin lymphoma (HL: N=323), and acute leukemia (Leuk: N=182), diagnosed at age 15-39y between 1998 to 2009, and treated at Kaiser Permanent Southern California (KPSC) were included in the study. KPSC is the largest integrated managed care organization in Southern California, with documented 5-year insurance retention rates for AYA cancer survivors approaching 80% (J Adolesc Young Adult Oncol 2013 2:59). A non-cancer comparison group (N=8,062) was constructed by selecting individuals enrolled in KPSC and matched to cancer survivors (1:10) on age at diagnosis, sex, health plan membership and calendar year. Time-dependent Poisson regression was used to derive incidence rate ratio (IRR) estimates and 95% confidence intervals (CI) for CVD (ICD-9 definition: heart failure, stroke, or myocardial infarction), adjusted for relevant covariates. Kaplan-Meier curves were generated for cancer survivors, stratified by CVD status. Definition of CVRFs (hypertension, diabetes, dyslipidemia) was per an algorithm developed by KPSC's case management system, which uses a combination of ICD-9 codes, laboratory test results, and documentation of receipt of medications for these conditions (Am J Epidemiol. 2014 179:27). Results: Median age at cancer diagnosis was 29y (range: 15-39 years); 53.4% were male; 58.2% were non-Hispanic white; diagnoses: HL (41.5%), NHL (35.2%), Leuk (23.4%). In cancer survivors, median time from cancer diagnosis to end of follow-up was 5.4y (range: 2-14.9y), representing 4,961 person-years of follow-up. Comparison with non-cancer controls: Multivariable analysis adjusted for age, sex, race/ethnicity, CVRFs, smoking history and overweight/obesity, revealed a significantly increased risk of CVD across all cancer diagnoses (Overall: IRR=3.5, 95%CI, 2.0-6.1) and by certain cancer types (Leuk: IRR=4.5, 95%CI, 1.8-11.2; HL: IRR=3.0, 95%CI, 1.0-8.9; NHL: IRR=2.0, 95%, 0.7-5.6) when compared to non-cancer controls. Modifiers of CVD risk: Hypertension, diabetes, and dyslipidemia were independent modifiers of CVD risk. Hypertension was associated with a 5.1-fold (95%CI, 2.1-12.1) increased risk, diabetes was associated with a 4.4-fold (95%CI, 1.9-9.9) increased risk, and dyslipidemia was associated with a 2.8-fold (95%CI, 1.2-6.6) increased risk of CVD in AYA survivors when compared to survivors without these CVRFs. Outcomes by CVD status among cancer survivors: Overall survival was significantly worse (5y: 64%, 10y: 56%) among cancer survivors who developed CVD when compared to survivors without CVD (5y: 95%, 10y: 91%), p<0.01 (Figure). Conclusions: Survivors of AYA hematologic malignancies are at increased risk for developing cardiovascular disease when compared to a matched non-cancer controls. In these survivors, overall survival following onset of CVD is especially poor, and cardiovascular risk factors are independent modifiers of delayed cardiovascular disease risk. Taken together these data form the basis for identifying high-risk individuals for population-based targeted surveillance, as well as aggressive management of cardiovascular risk factors. Figure 1. Figure 1. Disclosures No relevant conflicts of interest to declare.

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The Role of Antioxidants Supplementation in Clinical Practice: Focus on Cardiovascular Risk Factors

Antioxidants ◽

10.3390/antiox10020146 ◽

2021 ◽

Vol 10 (2) ◽

pp. 146

Author(s):

Vittoria Cammisotto ◽

Cristina Nocella ◽

Simona Bartimoccia ◽

Valerio Sanguigni ◽

Davide Francomano ◽

...

Keyword(s):

Oxidative Stress ◽

Risk Factors ◽

Cardiovascular Disease ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Antioxidant Supplementation ◽

Oxidative Stress Biomarkers ◽

Increased Risk ◽

Human Disorders ◽

Stress Burden

Oxidative stress may be defined as an imbalance between reactive oxygen species (ROS) and the antioxidant system to counteract or detoxify these potentially damaging molecules. This phenomenon is a common feature of many human disorders, such as cardiovascular disease. Many of the risk factors, including smoking, hypertension, hypercholesterolemia, diabetes, and obesity, are associated with an increased risk of developing cardiovascular disease, involving an elevated oxidative stress burden (either due to enhanced ROS production or decreased antioxidant protection). There are many therapeutic options to treat oxidative stress-associated cardiovascular diseases. Numerous studies have focused on the utility of antioxidant supplementation. However, whether antioxidant supplementation has any preventive and/or therapeutic value in cardiovascular pathology is still a matter of debate. In this review, we provide a detailed description of oxidative stress biomarkers in several cardiovascular risk factors. We also discuss the clinical implications of the supplementation with several classes of antioxidants, and their potential role for protecting against cardiovascular risk factors.

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