Carotid artery intima-media thickness (CIMT) in pediatric and young adult survivors of Hodgkin’s disease (HD)

Abstract

8516 Background: Long-term survivors of HD are at increased risk of death from coronary artery disease and stroke. Ultrasound measures of CIMT are a valid measure of atherosclerosis and are associated with an increased risk of future vascular disease. Methods: We compared CIMT in 20 HD survivors (14 male, 6 female, mean age 23 yrs) and 8 sibling controls (1 male, 7 female, mean age 25 yrs). 9/20 patients (pts) had “B” symptoms. All pts were in a continuous CR for a mean of 104 months, range 62–241 months. 19/20 pts received chemotherapy (CT), all 19 received doxorubicin. 11 pts received radiotherapy (RT) to bilateral neck, the field in 10/11 included the mediastinum. 8/11 had low dose RT (21–25 Gy), 3/11 had standard dose (36 Gy). CIMT was assessed using a standardized scanning and reading protocol. The CIMT was calculated as the mean of the maximum measurement at 12 sites: near and far walls of the common carotid, bifurcation, and internal carotid arteries bilaterally. Mean CIMT was analyzed by t-test and a linear mixed model was used to assess the effects of HD on CIMT after adjusting for other covariates including age, gender, race, cholesterol, smoking, blood pressure (BP) and C-reactive protein (CRP). Results: Mean CIMT was higher in HD pts than controls, 0.78 mm and 0.71 mm respectively, p=0.003. Analysis of matched sibling pairs confirmed this difference, p=0.002. The difference in CIMT was independent of age, gender, race, cholesterol, smoking, BP, and CRP. Among the HD patients, higher CIMT values were positively associated with increasing age, cholesterol, LDL-C, and diastolic BP. “B” symptoms and RT were not significantly associated with CIMT, although values were higher in the 3/11 pts who received 36 Gy. Conclusion: History of HD is associated with increased CIMT even in pts treated with CT alone. HD survivors had a CIMT of 0.78 mm, a value found in healthy individuals at age 65 suggesting the “vascular age” of the HD pts to be 25 years older than their chronological age. CIMT may be a useful risk screening tool of early cardiovascular disease in pediatric and young adult survivors of HD. No significant financial relationships to disclose.