RT Journal Article
SR Electronic
T1 Cardiovascular Family History Increases Risk for Late-Onset Adverse Cardiovascular Outcomes in Childhood Cancer Survivors: A St. Jude Lifetime Cohort Report
JF Cancer Epidemiology Biomarkers & Prevention
JO Cancer Epidemiol Biomarkers Prev
FD American Association for Cancer Research
SP 123
OP 132
DO 10.1158/1055-9965.EPI-20-0809
VO 30
IS 1
A1 Goldberg, Jason F.
A1 Ness, Kirsten K.
A1 Chi, Xiaofei
A1 Santucci, Aimee K.
A1 Plana, Juan Carlos
A1 Joshi, Vijaya M.
A1 Luepker, Russell V.
A1 Durand, Jean-Bernard
A1 Partin, Robyn E.
A1 Howell, Rebecca M.
A1 Wilson, Carmen L.
A1 Towbin, Jeffrey A.
A1 Jefferies, John L.
A1 Srivastava, Deo Kumar
A1 Hudson, Melissa M.
A1 Robison, Leslie L.
A1 Armstrong, Gregory T.
YR 2021
UL http://cebp.aacrjournals.org/content/30/1/123.abstract
AB Background: Survivors of childhood cancer have an increased risk of therapy-related cardiovascular disease. It is not known whether family history of cardiovascular disease further increases risk of adverse cardiovascular outcomes among survivors.Methods: Family history of cardiovascular disease was collected from 1,260 survivors [median age at diagnosis, 8 years (range, 0–23); age at last follow-up, 35 years (range, 18–66)] of childhood cancer in the St. Jude Lifetime Cohort Study. Multivariable risk models evaluated associations with cardiovascular disease (Common Terminology Criteria for Adverse Events grade 2–4 events) and cardiovascular risk factors.Results: Among survivors exposed to chest-directed radiation and/or anthracycline chemotherapy (n = 824), 7% reported a first-degree family history of heart failure, 19% myocardial infarction, 11% stroke, 26% atherosclerotic disease (myocardial infarction and/or stroke), 62% hypertension, and 31% diabetes mellitus. Eighteen percent of exposed survivors developed heart failure, 9% myocardial infarction, 3% stroke, 11% atherosclerotic disease, 30% hypertension, and 9% diabetes mellitus. Having a first-degree family history of atherosclerotic disease was independently associated with development of treatment-related heart failure [RR, 1.38; 95% confidence interval (CI), 1.01–1.88; P = 0.04] among exposed survivors. Risk for hypertension was increased among exposed survivors with a first-degree family history of hypertension (RR, 1.55; 95% CI, 1.26–1.92; P < 0.0001) or of any cardiovascular disease [myocardial infarction, stroke, or heart failure (RR, 1.30; 95% CI, 1.06–1.59; P = 0.01)].Conclusions: Family history of cardiovascular disease and cardiovascular risk factors independently increased risk of heart failure and hypertension among survivors of childhood cancer exposed to cardiotoxic therapies.Impact: These data show the importance of cardiovascular family history as a risk factor for cardiovascular disease in survivors of childhood cancer.