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Higher heart risk for survivors of childhood cancer

Cardiovascular problems eight years earlier than usual

Adrian O'Dowd

Friday, 09 March 2018

People who survive childhood cancer have a higher risk of suffering prematurely from cardiovascular disease as adults, suggests a study* published today in the European Heart Journal.

German researchers found that as adults, these people had almost double the risk of developing cardiovascular disease than the general population and were also more likely to have high blood pressure and dyslipidaemia six and eight years earlier, respectively.

Treatment of childhood cancer has improved significantly in recent decades with an average overall survival above 80%, meaning that adverse late effects among long-term childhood cancer survivors have become increasingly important.

Currently, around 33,000 long-term childhood cancer survivors are followed by the German Childhood Cancer Registry (GCCR) and cardiovascular disease is the most common non-neoplastic cause of premature mortality in this population.

A team of researchers led by Professor Joerg Faber, head of the Department of Paediatric Haematology/Oncology/Haemostaseology at the University Medical Centre of the Johannes Gutenberg University Mainz in Germany, set out to investigate the long-term health of childhood cancer survivors using systematic and comprehensive clinical evaluation of their health in comparison to the general population.

Between October 2013 and February 2016, a total of 951 adult long-term survivors of childhood cancer, who were part of the Cardiac and vascular late sequelae in long-term survivors of childhood cancer (CVSS) study, underwent a clinical examination that included assessing factors that might put them at higher risk of cardiovascular disease, such as high blood pressure and dyslipidaemia.

The researchers also checked their medical history, smoking status, and family history of cardiovascular disease. Their ages ranged from 23 to 48 at the time of this follow-up. Results were compared with more than 15,000 people selected from the general population.

Heart disease was found in 4.5% of cancer survivors and occurred in the majority before they reached the age of 40 – nearly eight years earlier than in the general population.

The results showed that, as adults, the cancer survivors had a nearly two-fold increased risk of cardiovascular diseases such as congestive heart failure and venous thromboembolism.

High blood pressure and dyslipidaemia were the most common cardiovascular risk factors identified in the cancer survivors – 23% and 28% respectively, whereas diabetes was only found in 2%.

These conditions occurred earlier than in the general population – 17% and 25% had high blood pressure or dyslipidaemia respectively before the age of 30, and 39% and 38% by the age of 45.

Professor Faber, one of the principal investigators, said: “Our results show that these survivors of childhood cancer have a substantially elevated burden of prematurely occurring traditional cardiovascular risk factors and cardiovascular diseases.”

The researchers said this higher risk continued to increase with age rather than levelling off.

Professor Wild, head of the Department of Preventive Cardiology and Preventive Medicine at the University Medical Centre of the Johannes Gutenberg University Mainz and principal investigator of the German Centre for Cardiovascular Research, said: “Early systematic screening, particularly focusing on blood pressure and lipid measurements, might be suggested in all childhood cancer survivors irrespective of the type of cancer or treatment they had had.

“This might help to prevent long-term cardiovascular diseases by intervening early, for instance by modifying life styles and having treatment for high blood pressure.”

*Faber J, Wingerter A et al. Burden of cardiovascular risk factors and cardiovascular disease in childhood cancer survivors: data from the German CVSS-study. European Heart Journal. DOI:10.1093/eurheartj/ehy026

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