Abstract
Childhood acute lymphoblastic leukemia (ALL) survivors are at an increased risk of cardiovascular disease development. It is believed that in the general population, this risk can be predicted with carotid intima-media thickness (CIMT) measurement. The objective of this study was to assess CIMT and to investigate the effects of blood pressure (BP) and lipid profile values on CIMT in childhood ALL survivors. The study group comprised 81 childhood ALL survivors aged 5-25 years. The control group consisted of 52 ageand sex-comparable healthy children. Carotid intima-media thickness measurement, 24-hour BP monitoring and lipid profiles were evaluated in patients and controls. Despite significantly higher proportion of subjects with arterial hypertension (AH) (30/81 vs 10/52; p = 0.0315), the mean values of CIMT were not statistically different in childhood ALL survivors as compared to controls (0.4303 ±0.03 vs 0.4291 ±0.03; p = 0.81 and 1.096 ±0.74 vs 1.027 ±0.55; p = 0.56, respectively). Carotid intima-media thickness values were not statistically higher in ALL survivors with AH as compared to ALL survivors with normal BP (0.433 ±0.03 vs 0.428 ±0.03; p = 0.82). A significant positive correlation between 24-hour systolic BP standard deviation score (SDS) and CIMT-SDS in childhood ALL survivors was found (r = 0.29, p = 0.009), whereas such correlation was not observed in healthy controls (r = 0.12, p = 0.39). A significant correlation between z-score body mass index (BMI) and CIMT was found in controls (r = 0.29, p = 0.031) but not in childhood ALL survivors (r = -0.05, p = 0.64). No significant correlations between CIMT and other measured variables were found. Carotid intima-media thickness did not significantly correlate with time since ALL diagnosis (r = 0.09, p = 0.39). Carotid intima-media thickness measurement shows limited feasibility and diagnostic accuracy for early assessment of vascular alteration in childhood ALL survivors. Other tests are needed to predict cardiovascular risk in childhood ALL survivors at the early stage of the follow-up.
Highlights
Carotid intima-media thickness (CIMT) is a recognized marker of endothelial dysfunction
A significant positive correlation between 24-hour systolic blood pressure (BP) standard deviation score (SDS) and carotid intima-media thickness (CIMT)-SDS in childhood acute lymphoblastic leukemia (ALL) survivors was found (r = 0.29, p = 0.009), whereas such correlation was not observed in healthy controls (r = 0.12, p = 0.39)
A significant correlation between z-score body mass index (BMI) and CIMT was found in controls (r = 0.29, p = 0.031) but not in childhood ALL survivors (r = −0.05, p = 0.64)
Summary
Carotid intima-media thickness (CIMT) is a recognized marker of endothelial dysfunction. Carotid intima-media thickness measurement has become a useful non-invasive method for cardiovascular risk assessment for adults and for children.[1]. Measurement of CIMT has established its utility as an important tool for evaluation of subclinical atherosclerosis.[1]. Increased CIMT was found in children with metabolic syndrome, congenital adrenal hyperplasia, obesity, type 1 diabetes mellitus, and in childhood cancer survivors.[2–7]. The lack of pediatric, population-based reference values makes CIMT not a widely accepted marker of subclinical atherosclerosis in youth with cardiovascular risk factors.[8]. It is believed that vascular alteration related to endothelial dysfunction leads to loss of vasodilatory capability and atherosclerosis.[12]. It is believed that in the general population, this risk can be predicted with carotid intima-media thickness (CIMT) measurement
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