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Eur Heart J. 2018 May 1;39(17):1555-1562. doi: 10.1093/eurheartj/ehy026.

Burden of cardiovascular risk factors and cardiovascular disease in childhood cancer survivors: data from the German CVSS-study.

Author information

1
Department of Pediatric Hematology/Oncology/Hemostaseology, Center for Pediatric and Adolescent Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany.
2
Center for Cardiology - Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany.
3
German Center for Cardiovascular Research (DZHK) Partner Site Rhine-Main, Langenbeckstraße 1, 55131 Mainz, Germany.
4
Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany.
5
Clinic for Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Untere Zahlbacher Straße 8, 55131 Mainz, Germany.
6
Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Obere Zahlbacher Straße 69, 55131 Mainz, Germany.
7
Institute for Biometrics and Epidemiology, German Diabetes Centre, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Auf'm Hennekamp 65, 40225 Düsseldorf, Germany.
8
German Center for Cardiovascular Disease Research (DZHK), Partner Site Munich, Technical University of Munich, Biedersteiner Straße 29, 80802 Munich, Germany.
9
Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany.
10
Institute for Cardiovascular Prevention, Ludwig-Maximilian-University Hospital, Pettenkoferstraße 9, 80336 Munich, Germany.
11
KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Stenglinstraße 2, 86156 Augsburg, Germany.
12
Department of Epidemiology and Health Monitoring, Robert Koch Institute, Nordufer 20, 13353 Berlin, Germany.
13
German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.
14
German Childhood Cancer Registry (GCCR), Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Obere Zahlbacher Straße 69, 55131 Mainz, Germany.
15
Center for Thrombosis and Haemostasis, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany.
16
Center for Translational Vascular Biology (CTVB), University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany.
17
Preventive Cardiology and Preventive Medicine, Centre for Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany.

Abstract

Aims:

The cardiac and vascular late sequelae in long-term survivors of childhood cancer (CVSS)-study aimed to quantify the prevalence of cardiovascular risk factors (CVRF) and cardiovascular disease (CVD) in German childhood cancer survivors (CCS).

Methods and results:

In the CVSS-study (NCT02181049), 1002 CCS (age range 23-48 years) diagnosed with neoplasia prior to 15 years of age between 1980 and 1990 prospectively underwent a systematic, standardized clinical and laboratory cardiovascular screening, identical to the population-based Gutenberg Health Study (GHS) cohort. For 951 individuals, prevalences of CVRF and CVD were primarily compared to the GHS sample and to two further German population-based cohorts. Using log-binomial regression models, an increased risk for occurrence of arterial hypertension [relative risk (RR) 1.38, 95% confidence interval (95% CI 1.21-1.57)] and dyslipidaemia [RR 1.26 (95% CI 1.12-1.42)] was found. This indicates a premature occurrence compared to the general population of approximately 6 and 8 years, respectively [rate advancement period estimator, RAPhypertension 5.75 (95% CI 3.5-8.0) and RAPdyslipidaemia 8.16 (95% CI 4.4-11.9)]. Overall, no differences were observed for obesity and diabetes. Overt CVD was present in 4.5% (95% CI 3.0-6.6%) of CCS [RR 1.89 (95% CI 1.34-2.66), RAPCVD 7.9 (95% CI 4.1-11.7)], of which the most frequent entities were congestive heart failure and venous thromboembolism. Prevalences of CVRF and CVD increased with age without reaching a plateau over time.

Conclusion:

This large CCS screening examination revealed consistently in comparison to three population samples a considerably increased risk for premature CVD. The findings in these young adult CCS indicate a high burden of cardiovascular morbidity and mortality in the long term.

Clinicaltrials. gov-Nr:

NCT02181049.

PMID:
29534171
DOI:
10.1093/eurheartj/ehy026

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