Characterization of Cardiac, Vascular, and Metabolic Changes in Young Childhood Cancer Survivors.

Olof Broberg,Constance G Weismann,Ingrid Øra,Thomas Wiebe,Petru Liuba

doi:10.3389/fped.2021.764679

Olof Broberg, Constance G Weismann + Show 3 more

Open Access

https://doi.org/10.3389/fped.2021.764679

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Abstract

Background: Childhood cancer survivors (CCS) are at an increased risk for cardiovascular diseases (CVD). It was the primary aim of this study to determine different measures of cardiac, carotid, lipid, and apolipoprotein status in young adult CCS and in healthy controls.Methods: Cardiac and common carotid artery (CCA) structure and function were measured by ultrasonography. Lipids and apolipoproteins were measured in the blood. Peripheral arterial endothelial vasomotor function was assessed by measuring digital reactive hyperemia index (PAT-RHI) using the Endo-PAT 2000.Results: Fifty-three CCS (20–30 years, 35 men) and 53 sex-matched controls were studied. The CCS cohort was divided by the median dose of anthracyclines into a low anthracycline dose (LAD) group (50–197 mg/m2, n = 26) and a high anthracycline dose (HAD) group (200–486 mg/m2, n = 27). Carotid distensibility index (DI) and endothelial function determined by PAT-RHI were both lower in the CCS groups compared with controls (p < 0.05 and p = 0.02). There was no difference in carotid intima media thickness. Atherogenic apolipoprotein-B (Apo-B) and the ratio between Apo-B and Apoliprotein-A1 (Apo-A1) were higher in the HAD group compared with controls (p < 0.01). Apo-B/Apo-A1-ratio was over reference limit in 29.6% of the HAD group, in 15.4% of LAD group, and in 7.5% of controls (p = 0.03). Measured lipid markers (low density lipoprotein and total cholesterol and triglycerides) were higher in both CCS groups compared with controls (p < 0.05). Systolic and diastolic function were measurably decreased in the HAD group, as evidenced by lower EF (p < 0.001) and lower é-wave (p < 0.005) compared with controls. CCA DI correlated with Apo-B/Apo-A1-ratio and Apo-A1. Follow-up time after treatment correlated with decreased left ventricular ejection fraction (p = 0.001).Conclusion: Young asymptomatic CCS exhibit cardiac, vascular, lipid, and apolipoprotein changes that could account for increased risk for CVD later in life. These findings emphasize the importance of cardiometabolic monitoring even in young CCS.

Highlights

Cardiovascular disease (CVD) including cardiomyopathy, ischemic heart disease, and cerebrovascular disease amount to the most prevalent non-cancerous causes of death in childhood cancer survivors (CCS) [1, 2]
As described in the Methods, based by the median AC dose, the CCS cohort was divided into two groups: low AC dose (LAD; n = 26) and high AC dose (HAD; n = 27)
Four CCS had been treated for rhabdomyosarcoma, one for Ewing’s sarcoma, one for osteosarcoma, five for Wilms’s tumor, 11 for Hodgkin’s disease, and eight for non-Hodgkin’s lymphoma

Summary

Introduction

Cardiovascular disease (CVD) including cardiomyopathy, ischemic heart disease, and cerebrovascular disease amount to the most prevalent non-cancerous causes of death in childhood cancer survivors (CCS) [1, 2]. Recent studies have shown that CCS have increased carotid intima media thickness (CIMT), stiffer arteries, and endothelial dysfunction [4,5,6,7,8]. These deviations are recognized as markers of early atherosclerosis and predict later onset of ventricular dysfunction, stroke, and ischaemic heart disease [9,10,11,12,13]. Childhood cancer survivors (CCS) are at an increased risk for cardiovascular diseases (CVD) It was the primary aim of this study to determine different measures of cardiac, carotid, lipid, and apolipoprotein status in young adult CCS and in healthy controls

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