Introduction: Childhood Cancer Survivors (CCS) have an increased risk of overweight and dyslipidemia, but the distribution and the potential relationships between anticancer therapies and these Cardiovascular (CV) risk factors have been heterogeneously described. Aim of this study is to evaluate the influence of previuos treatments in the developement of CV risk factors in a cohort of CCS. Methods: All consecutive CCS referring to our outpatient Clinic were enrolled. Hypercholesterolemia (defined as total cholesterol >200 mg/dl) was the primary end point, hypertriglyceridemia (triglycerids>200 mg/dl) and Body Mass Index >30 kg/m2 the second ones. Cox Multivariate adjustments were performed to account for differences in neoplasia and treatment. Results: 340 patients were included (197 male and 143 female): the most common pediatric cancer diagnosis were hematological malignancies (n=227) and brain tumors (n=51). After a median follow-up of 16.1 years, hypercholesterolemia was diagnosed in 87 CCS (25%), hypertriglyceridemia in 20 (6%) and obesity in 28 (8%). At multivariate adjustment, total body irradiation (TBI) and Growth Hormone Deficiency (GHD) increased the risk of both hypercholesterolemia (HR 2.7: 1.2-4.4 and 2.3: 1.1-4.9; all p<0.05) and hypertriglyceridemia (HR 6.5:1.4-31 and 7.2: 1.1-43 all p<0.05). The risk of hypercholesterolemia was also higher in CCS submitted to autologous hematopoietic stem cell transplantation (HR 3.2: 1.7-5.9 p<0.001) or platinum-based chemotherapy (HR 2.7: 1.5-4.9; p<0.001), whereas a previous diagnosis of brain tumor (HR 10: 1.2-45; p<0.05) and treatments with anthracyclines (HR 1.3: 1.2-26; p<0.05) significantly predicted obesity. Conclusion: Survivors of childhood cancer who developed GH deficiency and were exposed to TBI reported an increased risk of dislipidemia, while a diagnosis of brain tumor and a previous treatment with anthracyclines related to obesity. These patients need an accurate and tailored control of cardiovascular risk profile.
Prevalence of cardiovascular risk factors in long-term survivors of childhood cancer
F. Felicetti;D'ASCENZO, FABRIZIO;GAITA, Fiorenzo
2013-01-01
Abstract
Introduction: Childhood Cancer Survivors (CCS) have an increased risk of overweight and dyslipidemia, but the distribution and the potential relationships between anticancer therapies and these Cardiovascular (CV) risk factors have been heterogeneously described. Aim of this study is to evaluate the influence of previuos treatments in the developement of CV risk factors in a cohort of CCS. Methods: All consecutive CCS referring to our outpatient Clinic were enrolled. Hypercholesterolemia (defined as total cholesterol >200 mg/dl) was the primary end point, hypertriglyceridemia (triglycerids>200 mg/dl) and Body Mass Index >30 kg/m2 the second ones. Cox Multivariate adjustments were performed to account for differences in neoplasia and treatment. Results: 340 patients were included (197 male and 143 female): the most common pediatric cancer diagnosis were hematological malignancies (n=227) and brain tumors (n=51). After a median follow-up of 16.1 years, hypercholesterolemia was diagnosed in 87 CCS (25%), hypertriglyceridemia in 20 (6%) and obesity in 28 (8%). At multivariate adjustment, total body irradiation (TBI) and Growth Hormone Deficiency (GHD) increased the risk of both hypercholesterolemia (HR 2.7: 1.2-4.4 and 2.3: 1.1-4.9; all p<0.05) and hypertriglyceridemia (HR 6.5:1.4-31 and 7.2: 1.1-43 all p<0.05). The risk of hypercholesterolemia was also higher in CCS submitted to autologous hematopoietic stem cell transplantation (HR 3.2: 1.7-5.9 p<0.001) or platinum-based chemotherapy (HR 2.7: 1.5-4.9; p<0.001), whereas a previous diagnosis of brain tumor (HR 10: 1.2-45; p<0.05) and treatments with anthracyclines (HR 1.3: 1.2-26; p<0.05) significantly predicted obesity. Conclusion: Survivors of childhood cancer who developed GH deficiency and were exposed to TBI reported an increased risk of dislipidemia, while a diagnosis of brain tumor and a previous treatment with anthracyclines related to obesity. These patients need an accurate and tailored control of cardiovascular risk profile.
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