Predicting Cardiovascular Disease Among Testicular Cancer Survivors After Modern Cisplatin-based Chemotherapy: Application of the Framingham Risk Score.

Abstract

Testicular cancer survivors (TCSs) are at increased risk of cardiovascular disease (CVD) after cisplatin-based chemotherapy (CBCT). Identifying at-risk survivors would allow early intervention, but risk prediction tools such as the Framingham Risk Score (FRS) have not been applied to TCSs given modern chemotherapy. TCSs > 1 year post-CBCT were evaluated. Associations between FRS and clinical, socioeconomic, and lifestyle measures and treatment regimen (4 cycles, etoposide and cisplatin [EP× 4]); 3 or 4 cycles, bleomycin plus EP (BEP× 3, BEP× 4) were analyzed with general linear multivariable models. Controls from the National Health and Nutrition Examination Survey were matched 1:1 to TCSs by age, race, and education with differences in mean FRS evaluated with 2-sided t tests. Of 787 TCSs (median age, 37.3 years; median follow-up, 4.2 years), 284, 342, and 161 received EP× 4, BEP× 3, or BEP× 4, respectively. TCSs had higher median systolic blood pressure (126 vs. 119mm Hg; P< .001), but fewer were smokers (8.4% vs. 28.2%; P< .001) than controls. In multivariable analysis, no significant differences in FRS between EP× 4, BEP× 3, and BEP× 4 were observed, but less than college education (P< .001) and lack of vigorous exercise (P= .006) were associated with higher FRS. Mean FRS did not differ between TCSs and controls (6.8% vs. 7.3%; P= .67). This is the first study to apply the office-based FRS to TCSs. Chemotherapy regimen (BEP× 3 vs. EP× 4) was not associated with FRS, but less educated and less vigorously active patients had higher FRS, and present a high-risk subgroup for intense follow-up and counseling.