Modifiable risk factors and major cardiac events among adult survivors of childhood cancer Journal Article


Authors: Armstrong, G. T.; Oeffinger, K. C.; Chen, Y.; Kawashima, T.; Yasui, Y.; Leisenring, W.; Stovall, M.; Chow, E. J.; Sklar, C. A.; Mulrooney, D. A.; Mertens, A. C.; Border, W.; Durand, J. B.; Robison, L. L.; Meacham, L. R.
Article Title: Modifiable risk factors and major cardiac events among adult survivors of childhood cancer
Abstract: To evaluate the relative contribution of modifiable cardiovascular risk factors on the development of major cardiac events in aging adult survivors of childhood cancer. Among 10,724 5-year survivors (median age, 33.7 years) and 3,159 siblings in the Childhood Cancer Survivor Study, the prevalence of hypertension, diabetes mellitus, dyslipidemia, and obesity was determined, along with the incidence and severity of major cardiac events such as coronary artery disease, heart failure, valvular disease, and arrhythmia. On longitudinal follow-up, rate ratios (RRs) of subsequent cardiac events associated with cardiovascular risk factors and cardiotoxic therapy were assessed in multivariable Poisson regression models. Among survivors, the cumulative incidence of coronary artery disease, heart failure, valvular disease, and arrhythmia by 45 years of age was 5.3%, 4.8%, 1.5%, and 1.3%, respectively. Two or more cardiovascular risk factors were reported by 10.3% of survivors and 7.9% of siblings. The risk for each cardiac event increased with increasing number of cardiovascular risk factors (all P(trend) < .001). Hypertension significantly increased risk for coronary artery disease (RR, 6.1), heart failure (RR, 19.4), valvular disease (RR, 13.6), and arrhythmia (RR, 6.0; all P values < .01). The combined effect of chest-directed radiotherapy plus hypertension resulted in potentiation of risk for each of the major cardiac events beyond that anticipated on the basis of an additive expectation. Hypertension was independently associated with risk of cardiac death (RR, 5.6; 95% CI, 3.2 to 9.7). Modifiable cardiovascular risk factors, particularly hypertension, potentiate therapy-associated risk for major cardiac events in this population and should be the focus of future interventional studies.
Keywords: adolescent; adult; child; preschool child; aged; child, preschool; middle aged; mortality; neoplasm; neoplasms; heart disease; risk factors; risk factor; survivor; survivors; poisson distribution; heart diseases; humans; human; male; female; article
Journal Title: Journal of Clinical Oncology
Volume: 31
Issue: 29
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2013-10-10
Start Page: 3673
End Page: 3680
Language: English
PUBMED: 24002505
PROVIDER: scopus
PMCID: PMC3804290
DOI: 10.1200/JCO.2013.49.3205
DOI/URL:
Notes: Export Date: 3 February 2014 -- Source: Scopus
Altmetric
Citation Impact
MSK Authors
  1. Charles A Sklar
    312 Sklar
  2. Kevin Oeffinger
    294 Oeffinger