Survivors of childhood cancers at substantial risk for cardiovascular disease

Risk for adverse cardiovascular outcomes, including congestive heart failure, myocardial infarction, pericardial disease and valvular abnormalities, was elevated among young adult survivors of childhood cancers, as late as 30 years post-therapy.

“Young adults who survive childhood or adolescent cancer are clearly at risk for early cardiac morbidity and mortality not typically recognized within this age group; such individuals require ongoing clinical monitoring, particularly as they approach ages in which cardiovascular disease becomes more prevalent,” researchers said.

In a retrospective study using questionnaires, the researchers compared the incidence of cardiovascular disease more than five years after diagnosis among 14,358 participants of the Childhood Cancer Survivor Study with that of incidence among 3,899 siblings.

Survivor participants included those diagnosed when aged younger than 21 years with leukemia, brain cancer, Hodgkin’s lymphoma, non-Hodgkin’s lymphoma, kidney cancer, neuroblastoma, soft tissue carcinoma or bone cancer between 1970 and 1986.

The prevalence of congestive heart failure was 1.7% for survivors vs. 0.2% for siblings. For valvular abnormalities, prevalence was 1.6% in survivors and 0.5% in siblings, and for pericardial disease, prevalence was 1.3% in survivors vs. 0.3% in siblings.

In adjusted analysis, the HR for survivors compared with siblings was 6.3 (95% CI, 3.3-11.9) for pericardial disease, 5.9 (95% CI, 3.4-9.6) for congestive heart failure and 5.0 (95% CI, 2.3-10.4) for myocardial infarction. The HR for valvular abnormalities was 4.8 (95% CI, 3.0-7.6).

An association was noted for elevated risk among survivors of leukemia, Hodgkin’s lymphoma, neuroblastoma and bone cancer and each cardiac outcome analyzed.

Anthracycline exposure of 250 mg/m² or more was linked to a two- to fivefold increased risk for congestive heart failure, pericardial disease and valvular abnormalities. Exposure to cardiac radiation of 1,500 cGy or more was linked to a two- to sixfold elevated risk for congestive heart failure, myocardial infarction, pericardial disease and valvular abnormalities.

Mulrooney DA. BMJ. 2009;doi:10.1136/bmj.b4606.