Preexisting cardiovascular risk and subsequent heart failure among non-Hodgkin lymphoma survivors Journal Article


Authors: Salz, T.; Zabor, E. C.; de Nully Brown, P.; Oksberg Dalton, S.; Raghunathan, N. J.; Matasar, M. J.; Steingart, R.; Vickers, A. J.; Munksgaard, P. S.; Oeffinger, K. C.; Johansen, C.
Article Title: Preexisting cardiovascular risk and subsequent heart failure among non-Hodgkin lymphoma survivors
Abstract: Purpose The use of anthracycline chemotherapy is associated with heart failure (HF) among survivors of non-Hodgkin lymphoma (NHL). We aimed to understand the contribution of preexisting cardiovascular risk factors to HF risk among NHL survivors. Methods Using Danish registries, we identified adults diagnosed with aggressive NHL from 2000 to 2010 and sex- and age-matched general-population controls. We assessed HF from 9 months after diagnosis through 2012. We used Cox regression analysis to assess differences in risk for HF between survivors and general population controls. Among survivors only, preexisting cardiovascular factors (hypertension, dyslipidemia, and diabetes) and preexisting cardiovascular disease were ascertained. We used multivariable Cox regression to model the association of preexisting cardiovascular conditions on subsequent HF. Results Among 2,508 survivors of NHL and 7,399 controls, there was a 42% increased risk of HF among survivors compared with general population controls (hazard ratio [HR], 1.42; 95% CI, 1.07 to 1.88). Among survivors (median age at diagnosis, 62 years; 56% male), 115 were diagnosed with HF during follow-up (median years of follow-up, 2.5). Before NHL diagnosis, 39% had $ 1 cardiovascular risk factor; 92% of survivors were treated with anthracycline-containing regimens. In multivariable analysis, intrinsic heart disease diagnosed before lymphoma was associated with increased risk of HF (HR, 2.71; 95% CI, 1.15 to 6.36), whereas preexisting vascular disease had no association with HF (P . .05). Survivors with cardiovascular risk factors had an increased risk of HF compared with those with none (for 1 v 0 cardiovascular risk factors: HR, 1.63; 95% CI, 1.07 to 2.47; for $ 2 v 0 cardiovascular risk factors: HR, 2.86; 95% CI, 1.56 to 5.23; joint P, .01). Conclusion In a large, population-based cohort of NHL survivors, preexisting cardiovascular conditions were associated with increased risk of HF. Preventive approaches should take baseline cardiovascular health into account. © 2017 by American Society of Clinical Oncology.
Keywords: adult; controlled study; aged; middle aged; retrospective studies; major clinical study; case control study; case-control studies; mortality; hypertension; pathophysiology; cancer staging; follow up; cancer diagnosis; neoplasm staging; proportional hazards models; risk factors; pathology; retrospective study; risk factor; survivor; cancer survivor; risk assessment; survivors; nonhodgkin lymphoma; register; registries; proportional hazards model; lymphoma, non-hodgkin; cardiovascular disease; cardiovascular risk; heart failure; cardiovascular diseases; diabetes mellitus; predictive value of tests; insurance; dyslipidemia; neoplasm invasiveness; anthracycline; anthracyclines; predictive value; denmark; tumor invasion; humans; human; male; female; priority journal; article; preexisting condition coverage
Journal Title: Journal of Clinical Oncology
Volume: 35
Issue: 34
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2017-12-01
Start Page: 3837
End Page: 3843
Language: English
DOI: 10.1200/jco.2017.72.4211
PUBMED: 28922087
PROVIDER: scopus
PMCID: PMC5707207
DOI/URL:
Notes: Article -- Export Date: 2 January 2018 -- Source: Scopus
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MSK Authors
  1. Talya Salz
    31 Salz
  2. Richard M Steingart
    113 Steingart
  3. Emily Craig Zabor
    121 Zabor
  4. Andrew J Vickers
    556 Vickers
  5. Matthew J Matasar
    119 Matasar