Subclinical Arteriosclerosis is Associated With Common Vascular Risk Factors in Long-Term Survivors of Testicular Cancer.

Javier Espíldora-Hernández,Tania Díaz-Antonio,José Rioja,Inmaculada Alonso-Calderón,Miguel-Ángel Sánchez-Chaparro,Pedro Valdivielso,Javier Baena-Espinar,Emilio Alba-Conejo

doi:10.3390/jcm9040971

Abstract

Cardiovascular disease risk is increased in survivors of testicular cancer because of exposure to treatment (chemotherapy and radiotherapy), as well as modification in lifestyle. Our aim was to assess the presence of subclinical arteriosclerosis in survivors of testicular cancer in comparison with a control group. This was a cross-sectional, observational, case–control study including 50 survivors of Germ Cell Tumor (GCT) (14 years of follow-up) and 53 age-matched controls with no cancer. We registered clinical data, cardiovascular risk factors, physical and Mediterranean questionnaires, intima-media thickness and plaque at carotid and femoral arteries by ultrasound, calcium score at the abdominal aorta, and liver steatosis by computed tomography, and applied analytical tests to quantify metabolic risk factors and inflammation markers. Patients showed a trend toward greater intima-media thickness (IMT) and plaques than controls, as well as a higher calcium score in the abdominal aorta. Remarkably, patients had higher waist circumference, insulin resistance (HOMA-IR), and liver steatosis, but lower physical activity and high-density lipoprotein (HDL) cholesterol than controls (all p < 0.05). In multivariate analyses, only common vascular risk factors were associated with subclinical arteriosclerosis. As a conclusion, in our study, a higher rate of subclinical arteriosclerosis in testicular cancer survivors was associated with classical metabolic risk factors and lifestyle, but not with exposure to chemotherapy.

Highlights

Cardiovascular disease is a major concern in long-term survivors of cancer [1,2,3], especially if they are young [4]
Atherosclerosis is a progressive disease characterized by the accumulation of lipids and fibrous elements in large arteries, which evolves towards arterial calcification [13]; it remains asymptomatic for many years until the plaques break, and the disease is complicated by thrombosis or vascular occlusion is done by significant stenosis [14]
germ cell tumor (GCT) survivors showed a clear trend toward greater subclinical arteriosclerosis than age-matched controls, reaching statistical significance at the total number of plaques found in the arterial territories explored by ultrasonography as well as the proximal area of the abdominal aorta (AACS)

Summary

Introduction

Cardiovascular disease is a major concern in long-term survivors of cancer [1,2,3], especially if they are young [4]. This is the case for testicular cancer, the most common malignancy among men 14 to 44 years of age [5]. Subclinical arteriosclerosis (SA) can be assessed by the presence of plaques in carotid and femoral arteries as well as calcification in the abdominal aorta Both are independent predictors of ischemic vascular events and death [15,16]

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