Paediatric cancer history exacerbates CVD risks for metabolic conditions

  • Circulation

  • International Clinical Digest
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Takeaway

  • Survivors of childhood cancer who have diabetes or hypertension have tripled risk for some cardiovascular diseases (CVD) compared with counterparts without these conditions.

Why this matters

  • These patients are caught in a dilemma: their cancer therapies leave them at increased risk for diabetes or hypertension, which in turn ups their CVD risk.
  • Clinicians should focus on modifiable factors, the authors say, as obviously these patients cannot safely forgo cancer treatments. 

Key results

  • Survivors had 3.2 (95% CI, 2.8-3.6) vs 0.9 (95% CI, 0.9-1.9) cardiac events/1000 person-years in the general population.
  • CVD diagnosis risk (HRs; 95% CIs) increased with:
    • Cancer relapse in childhood or later cancer: 1.7 (1.1-2.7);
    • Exposure to anthracycline chemotherapy ≥250 mg/mof doxorubicin-equivalent vs 2 or no exposure: 2.0 (1.4-2.9); and
    • Diabetes: 3.0 (1.6-5.8).
  • HRs for heart failure (HF) increased with:
    • Childhood relapse/later cancer: 2.0 (1.1-3.7);
    • Anthracycline exposure: 8.6 (4.5-16.6); 
    • Diabetes: 4.3 (1.8-10.7); and
    • Hypertension: 3.1 (1.3-7.9).

Study design

  • Paediatric cancer registry data, Ontario, including 7289 5-year survivors of cancer diagnosed at age 
  • Participants were matched to 5 people from the general population without cancer (n=36,205).
  • Funding: Canadian Institutes for Health Research.

Limitations

  • No data on several relevant lifestyle factors.