medwireNews: Young adult survivors of childhood cancer are at increased risk for cardiovascular disease (CVD), which develops earlier than in the general population, German study findings confirm.
The results of the CVSS (Cardiac and Vascular Late Sequelae in Long-Term Survivors of Childhood Cancer) study showed that childhood cancer survivors were a significant 1.89 times more likely to have CVD than their peers in the general population, with survivors developing CVD 7.9 years earlier, on average.The study involved 951 men and women who were diagnosed with cancer at a mean age of 6.1 years and then assessed for CV risk a mean 28.4 years later.
Compared with participants of the population-based Gutenberg Health Study (GHS) cohort, those in the CVSS study had an age-adjusted 38% increased risk for hypertension and a 26% increased risk for dyslipidaemia, but were not more likely to have diabetes or be obese.
Hypertension and dyslipidemia were present in 23.0% and 28.3% of survivors, respectively, and developed 6 to 8 years earlier than in the general population.
Overt CVD was detected in 4.5% of CVSS participants and most commonly presented as venous thromboembolism (VTE; 2.0%) and congestive heart failure (CHF; 1.2%).
The age-adjusted relative risk for VTE was a significant 1.77 times higher in the CVSS cohort than in the GHS study, while the risk for CHF was a significant 6.76 times higher.
Jörg Faber (University Medical Center of the Johannes Gutenberg University Mainz, Germany) and co-investigators also found that the prevalence of both CV risk factors and CVD increased over time without reaching a plateau.
They estimated that 17.1% and 24.7% of CVSS participants would have hypertension and dyslipidaemia, respectively, by age 30 years, increasing to 39.3% and 38.0% by the age of 45 years. The corresponding rates for CVD and CHF were 2.9% and 0.8% at age 30 years and 9.6% and 2.3% at age 45 years.
Writing in the European Heart Journal, the researchers conclude: “Early focused cardiovascular screening including measurements of blood pressure and lipid profiles should be offered to [childhood cancer survivors] and not only to high risk subgroups as recommended by current guidelines.”
However, in an accompanying editorial, John Groarke, from the Brigham and Women’s Hospital Heart and Vascular Center, in Boston, Massachusetts, USA, points out that “[c]ardiovascular screening of childhood cancer survivors is fraught with challenges, not least related to the latency between cancer therapies and expression of CV injury.”
He therefore suggests that survivors must be empowered “to share in the burden of CV surveillance,” by being “informed of clinical signs and symptoms that should prompt medical review.”
Groarke adds: “While this work by Faber and colleagues reinforces the excess burden of CV risk factors and disease among childhood cancer survivors, future studies must now focus on the many knowledge gaps in mechanisms, diagnosis, screening, prevention, and management of CV injury in this cohort.”
He concludes: “It is time to progress from risk observation to risk modification.”
By Laura Cowen
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