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Traditional Cardiovascular Risk Factors and Individual Prediction of Cardiovascular Events in Childhood Cancer Survivors

JNCI : Journal of the National Cancer Institute, 2020-03, Vol.112 (3), p.256-265 [Peer Reviewed Journal]

The Author(s) 2019. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com. 2019 ;The Author(s) 2019. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com. ;ISSN: 0027-8874 ;EISSN: 1460-2105 ;DOI: 10.1093/jnci/djz108 ;PMID: 31161223

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Title:
Traditional Cardiovascular Risk Factors and Individual Prediction of Cardiovascular Events in Childhood Cancer Survivors
Author: Chen, Yan ; Chow, Eric J ; Oeffinger, Kevin C ; Border, William L ; Leisenring, Wendy M ; Meacham, Lillian R ; Mulrooney, Daniel A ; Sklar, Charles A ; Stovall, Marilyn ; Robison, Leslie L ; Armstrong, Gregory T ; Yasui, Yutaka
Subjects: Adolescent ; Adult ; Age ; Anthracycline ; Cancer ; Cancer Survivors - statistics & numerical data ; Cancer therapies ; Cardiovascular disease ; Cardiovascular diseases ; Cardiovascular Diseases - epidemiology ; Cardiovascular Diseases - etiology ; Chemotherapy ; Child ; Child, Preschool ; Children ; Congestive heart failure ; Coronary artery disease ; Diabetes ; Diabetes mellitus ; Dyslipidemia ; Exposure ; Female ; Health risks ; Heart diseases ; Heart failure ; Humans ; Hypertension ; Ischemia ; Longitudinal Studies ; Male ; Middle Aged ; Neoplasms - epidemiology ; Neoplasms - therapy ; Prediction models ; Radiation therapy ; Replication ; Risk ; Risk analysis ; Risk factors ; Risk groups ; Siblings ; Statistics ; Stroke ; Survival ; United States - epidemiology ; Young Adult
Is Part Of: JNCI : Journal of the National Cancer Institute, 2020-03, Vol.112 (3), p.256-265
Description: Abstract Background Childhood cancer survivors have an increased risk of heart failure, ischemic heart disease, and stroke. They may benefit from prediction models that account for cardiotoxic cancer treatment exposures combined with information on traditional cardiovascular risk factors such as hypertension, dyslipidemia, and diabetes. Methods Childhood Cancer Survivor Study participants (n = 22 643) were followed through age 50 years for incident heart failure, ischemic heart disease, and stroke. Siblings (n = 5056) served as a comparator. Participants were assessed longitudinally for hypertension, dyslipidemia, and diabetes based on self-reported prescription medication use. Half the cohort was used for discovery; the remainder for replication. Models for each outcome were created for survivors ages 20, 25, 30, and 35 years at the time of prediction (n = 12 models). Results For discovery, risk scores based on demographic, cancer treatment, hypertension, dyslipidemia, and diabetes information achieved areas under the receiver operating characteristic curve and concordance statistics 0.70 or greater in 9 and 10 of the 12 models, respectively. For replication, achieved areas under the receiver operating characteristic curve and concordance statistics 0.70 or greater were observed in 7 and 9 of the models, respectively. Across outcomes, the most influential exposures were anthracycline chemotherapy, radiotherapy, diabetes, and hypertension. Survivors were then assigned to statistically distinct risk groups corresponding to cumulative incidences at age 50 years of each target outcome of less than 3% (moderate-risk) or approximately 10% or greater (high-risk). Cumulative incidence of all outcomes was 1% or less among siblings. Conclusions Traditional cardiovascular risk factors remain important for predicting risk of cardiovascular disease among adult-age survivors of childhood cancer. These prediction models provide a framework on which to base future surveillance strategies and interventions.
Publisher: United States: Oxford University Press
Language: English
Identifier: ISSN: 0027-8874
EISSN: 1460-2105
DOI: 10.1093/jnci/djz108
PMID: 31161223
Source: Geneva Foundation Free Medical Journals at publisher websites
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Traditional Cardiovascular Risk Factors and Individual Prediction of Cardiovascular Events in Childhood Cancer Survivors

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