Cardiovascular Abnormalities Found in Childhood Cancer Survivors Unexposed to Cardiotoxic Agents

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(ChemotherapyAdvisor) – Despite not receiving cardiotoxic treatments, survivors of cancer in childhood were found to have cardiovascular abnormalities “related not only to abnormal left ventricular (LV) structure and function but also to increased traditional risk factors for atherosclerotic disease and systemic inflammation,” results of a study in the Journal of Clinical Oncology online March 5 concluded.

Survivors of childhood cancers — which number at least 325,000 in the U.S. — are at higher risk for chronic disease and premature death throughout their lives. Survivorship guidelines should therefore address cardiovascular-related complications, which are of particular concern, the investigators noted.

The Cardiac Risk Factors in Childhood Cancer Survivors Study assessed echocardiographic characteristics and atherosclerotic disease risk in 201 survivors of childhood cancer with (n=156) and without (n=45) exposure to cardiotoxic treatments; 76 sibling controls were included. Median follow-up after diagnosis was 11 years (range, 3 to 32 years).

Those exposed to cardiotoxic treatments had below normal LV mass, wall thickness, contractility, and fractional shortening and above normal LV afterload. Unexposed survivors also had below normal LV mass overall; females had below normal LV wall thickness.

Compared with siblings, survivors had higher levels of N-terminal pro-brain natriuretic peptide, higher mean fasting serum levels of non–high-density lipoprotein cholesterol, higher insulin levels, and higher levels of high-sensitivity C-reactive protein (P<0.001 for all comparisons) regardless of exposure.

The 30-year risk of myocardial infarction, stroke, or coronary death was also higher for exposed and unexposed survivors vs. siblings (P<0.01 for both comparisons).

“Our findings suggest that all survivors have a higher long-term risk of cardiovascular diseases and may benefit from screening across several cardiovascular domains,” the investigators wrote.


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