Insulin resistance and risk factors for cardiovascular disease in young adult survivors of childhood acute lymphoblastic leukemia Journal Article


Authors: Oeffinger, K. C.; Adams-Huet, B.; Victor, R. G.; Church, T. S.; Snell, P. G.; Dunn, A. L.; Eshelman-Kent, D. A.; Ross, R.; Janiszewski, P. M.; Turoff, A. J.; Brooks, S.; Vega, G. L.
Article Title: Insulin resistance and risk factors for cardiovascular disease in young adult survivors of childhood acute lymphoblastic leukemia
Abstract: Purpose To determine the prevalence of insulin resistance and other risk factors for cardiovascular disease (CVD) in young adult survivors of childhood acute lymphoblastic leukemia (ALL). Patients and Methods In this cross-sectional evaluation of 118 survivors of childhood ALL (median age, 23.0 years; range, 18 to 37 years), insulin resistance was estimated using the homeostasis model for assessment of insulin resistance (HOMA-IR). Sex-specific comparisons were made with a cohort of 30-to 37-year-old individuals from the same region participating in the Dallas Heart Study (DHS, N = 782). ALL survivors were stratified by treatment with and without cranial radiotherapy (CRT). Results Female ALL survivors had a significantly higher HOMA-IR (CRT, mean 4.6, 95% CI, 3.6 to 5.7; no CRT, mean 3.3, 95% CI, 2.8 to 3.8) in comparison with DHS women (mean 2.4, 95% CI, 2.2 to 2.7). Eighty percent of women treated with CRT had at least three of six CVD risk factors, and they were significantly more likely to have three or more risk factors compared with DHS women (odds ratio [OR], 5.96; 95% CI, 2.15 to 16.47). Male ALL survivors had a significantly higher HOMA-IR (CRT, mean 4.0, 95% CI, 2.8 to 5.6; no CRT, mean 3.4, 95% CI, 2.9 to 3.9) in comparison with DHS men (mean 2.3, 95% CI, 2.1 to 2.6), but were not more likely to have multiple CVD risk factors. Conclusion ALL survivors had an increased prevalence of insulin resistance in comparison with a cohort of older individuals from the same community. Importantly, women treated with CRT seem to have an increased prevalence of multiple CVD risk factors, warranting close monitoring and riskreducing strategies. J Clin Oncol 27: 3698-3704. (C) 2009 by American Society of Clinical Oncology
Keywords: cancer survivor; children; long-term survivors; follow-up; metabolic syndrome; growth-hormone deficiency; c-reactive-protein; beta-cell function; homeostasis model assessment; bogalusa heart
Journal Title: Journal of Clinical Oncology
Volume: 27
Issue: 22
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2009-08-01
Start Page: 3698
End Page: 3704
Language: English
ACCESSION: ISI:000268502500021
DOI: 10.1200/jco.2008.19.7251
PROVIDER: wos
PMCID: PMC2720083
PUBMED: 19564534
Notes: --- - Article - "Source: Wos"
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  1. Kevin Oeffinger
    286 Oeffinger