Burden of cardiovascular risk factors and cardiovascular disease in childhood cancer survivors: data from the German CVSS-study

Abstract

Aims

The cardiac and vascular late sequelae in long-term survivors of childhood cancer (CVSS)-study aimed to quantify the prevalence of cardiovascular risk factors (CVRF) and cardiovascular disease (CVD) in German childhood cancer survivors (CCS).

Methods and results

In the CVSS-study (NCT02181049), 1002 CCS (age range 23–48 years) diagnosed with neoplasia prior to 15 years of age between 1980 and 1990 prospectively underwent a systematic, standardized clinical and laboratory cardiovascular screening, identical to the population-based Gutenberg Health Study (GHS) cohort. For 951 individuals, prevalences of CVRF and CVD were primarily compared to the GHS sample and to two further German population-based cohorts. Using log-binomial regression models, an increased risk for occurrence of arterial hypertension [relative risk (RR) 1.38, 95% confidence interval (95% CI 1.21–1.57)] and dyslipidaemia [RR 1.26 (95% CI 1.12–1.42)] was found. This indicates a premature occurrence compared to the general population of approximately 6 and 8 years, respectively [rate advancement period estimator, RAP_{h  ypertension} 5.75 (95% CI 3.5–8.0) and RAP_{d  yslipidaemia} 8.16 (95% CI 4.4–11.9)]. Overall, no differences were observed for obesity and diabetes. Overt CVD was present in 4.5% (95% CI 3.0–6.6%) of CCS [RR 1.89 (95% CI 1.34–2.66), RAP_CVD 7.9 (95% CI 4.1–11.7)], of which the most frequent entities were congestive heart failure and venous thromboembolism. Prevalences of CVRF and CVD increased with age without reaching a plateau over time.

Conclusion

This large CCS screening examination revealed consistently in comparison to three population samples a considerably increased risk for premature CVD. The findings in these young adult CCS indicate a high burden of cardiovascular morbidity and mortality in the long term.

Clinicaltrials. gov-Nr

NCT02181049.

Cardiotoxicity , Long-term survivors , Late sequelae , Cardiovascular morbidity , Cardio-oncology