Risk of atherosclerotic disease coronary artery lesions in childhood cancer survivors.

Abstract

e19586 Background: Increases in several traditional risk factors for atherosclerotic disease (AthD) such as cholesterol may partially explain the recently documented increased incidence of early cardiovascular disease (CVD) in survivors. The ability to aggregate these traditional risk factors into a single measure of AthD risk may not only help identify the cause of increased early CVD in survivors but also improve the interpretation of traditional risk factor testing. This has recently become possible using the NIH Pathobiological Determinants of Atherosclerosis Study's risk scoring system (PDAY) that predicts risk of an AthD coronary artery lesion in 15- to 34-yr olds. Methods: Risk factors were measured in a representative sample of 101 survivors and 31 siblings from 15-34 yrs old in an NCI prospective cohort study in Rochester, NY from 1999-2004. Risk factors were aggregated using PDAY, a weighted combination of age, sex, total cholesterol, HDL-cholesterol, smoking, systolic BP, hyperglycemia, and BMI. Survivors were compared to siblings after adjusting for age and sex. Results: Survivors were a mean 14 yrs from diagnosis; 57% received anthracyclines, 41% cardiac radiation, 48% cranial radiation, and 5% total body radiation as part of multiagent therapy. Survivors had similar AthD lesion risk as siblings (p = .83) which increased for males and by age. Conclusions: Similar estimates of AthD risk between survivors and siblings suggests much of the increase in early CVD incidence observed in follow-up studies of survivors is due to the direct effects of cancer treatment such as radiation exposure. Total CVD risk is a combination of this increased risk and that due to traditional risk factors. PDAY provides clinicians caring for survivors a new easy to use and cost free tool to assess the latter. Thus, PDAY may improve survivorship care by increasing understanding of how traditional AthD risk factors predispose to future CVD, identifying survivors requiring further assessment, and hopefully increasing compliance with risk reduction strategies. Mean (range) PDAY risk estimate of AthD lesions for survivor subgroups 15-24-yr-old females 15-24-yr-old males 25-34-yr-old females 25-34-yr-old males <1% (0-8%) 3% (0-24%) 9% (3-26%) 18% (7-42%) No significant financial relationships to disclose.