Heart Risks in Survivors
New Studies Reveal Multiple Cardiovascular Risks Facing Adult Childhood Cancer Survivors
Anonymous
Research on adult survivors of childhood cancer highlights several contributors to cardiovascular risk beyond cancer treatment, including emotional distress, genetic variation, and accumulated cardiovascular conditions. In one cohort, stress and distress were associated with hypertension, dyslipidemia, and metabolic syndrome, and with increased risk of some newly developing cardiovascular conditions. Separate studies investigated whether variants in TTN and BAG3 are associated with late-onset treatment-related cardiomyopathy, and whether the cumulative burden of non-major cardiovascular conditions is linked to later major events such as cardiomyopathy, heart attack, or stroke. A serum-protein model distinguished survivors with severe or symptomatic cardiomyopathy from matched survivors without it, correctly classifying 19 of 23 pairs in an independent sample. A 10-year cardiomyopathy prediction model based on age, sex, and treatment exposures performed well in two survivor cohorts, with genetic risk scores modestly improving performance in the validation cohort.
Key Points
1
In follow-up averaging 3.9 years, stress/distress was associated with new-onset dysrhythmia (risk ratio 2.87); perceived stress was associated with new-onset hypertension, while post-traumatic stress symptoms and anxiety were associated with new-onset dyslipidemia.
2
The serum biomarker study profiled 867 proteins and 218 metabolites in 75 matched pairs of survivors with subclinical cardiomyopathy and survivors without it. Its final 27-protein model correctly distinguished 19 of 23 matched pairs in an independent sample.
3
The 10-year prediction model defined cardiomyopathy as severe disease requiring heart-failure medication or transplantation, or leading to death. During follow-up, it was identified in 75 of 3,479 SJLIFE survivors and reported by 87 of 6,875 CCSS survivors.
4
The clinical prediction model used sex, age at cancer diagnosis, cumulative anthracycline dose, and mean heart radiation dose; its AUC was 0.833 in SJLIFE and 0.812 in CCSS. Adding genetic risk scores raised the CCSS AUC to 0.822, but did not improve performance in the development cohort.
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