Childhood cancer survivors at greater risk of premature CVD

Survivors of childhood cancer are quicker to develop hypertension and high cholesterol by six and eight years, respectively, when compared to the general population, according to a study published online March 9 in the European Heart Journal.

Joerg Faber, MD, PhD, and colleagues studied 951 adult survivors of childhood cancer in a German registry and compared them to more than 15,000 people from the general population. They found cancer survivors were at an age-adjusted 38 percent increased risk of arterial hypertension and a 26 percent increased risk of dyslipidemia.

Overt cardiovascular disease (CVD) was nearly twice as common in those who had survived childhood cancer, most frequently from congestive heart failure or venous thromboembolism.

"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,” coauthor Phillipp S. Wild, MD, MSc, said in a press release. “This might help to prevent long-term cardiovascular diseases by intervening early, for instance by modifying lifestyles and having treatment for high blood pressure."

The authors also pointed out that 80 percent of the survivors with high blood pressure were diagnosed for the first time during the study—further supporting the need for early screening in this population.

“The data suggest that (cardiovascular risk factors) and CVD occur prematurely in CCS (childhood cancer survivors), and the burden increases markedly with age without reaching a plateau,” they wrote. “Notably, the difference in risk compared to the general population seemed not to alter with age.”

In an accompanying editorial, John D. Groarke, MD, MPH, a cardiovascular medicine specialist at Brigham and Women’s Hospital in Boston, pointed out less than half of the cancer survivors who had hypertension or high cholesterol were on any cardiovascular medications.

“Although many factors contribute, use of pharmacological interventions in less than half of survivors with hypertension and/or dyslipidemia is probably in part related to a reluctance to initiate drug therapy in younger patients (mean age of survivors in this cohort was 34 years),” he wrote. “While lifestyle changes are at the cornerstone of blood pressure and lipid management, a lower threshold for pharmacological intervention seems appropriate for this high-risk cohort.”

Groarke said healthcare providers must engage childhood cancer survivors to be active in their own care and recognize cardiovascular symptoms that require medical review. But he also challenged researchers to take the medical field’s understanding of this relationship to the next level.

“Our understanding of the multifactorial pathobiology of premature CV disease in childhood cancer survivors that involves a complex interaction of cancer, cancer treatments, traditional CV risk factors, ageing, and genetics is incomplete,” he wrote. “There is a pressing need for research to inform practice guidelines for screening, prevention, and management.

“There are now sufficient observational data that childhood cancer survivors represent a high-CV risk cohort that warrant more comprehensive care systems to improve CV outcomes. It is time to progress from risk observation to risk modification.”