Abstract
Background and aimsLymphoma patients are frequently treated with cancer therapies that may increase the risk of adverse health outcomes later in life, including cardiovascular disease (CVD) mortality. We sought to investigate the long‐term risk of CVD incidence in this survivor population relative to the general population to quantify this health burden.MethodsA systematic review and meta‐analysis was conducted using EMBASE, MEDLINE, and CINAHL databases, from date of inception to November 2016, with additional searches completed through June 2018. Included reports were observational studies assessing CVD incidence in patients of either Hodgkin or non‐Hodgkin lymphoma (HL, NHL) who survived for at least 5 years from the time of diagnosis or if the study had a median follow‐up of 10 years. Meta‐analyses were performed using random effects models, and subgroup analyses were conducted to determine the incidence of specific CVD subtypes (coronary heart disease, pericardial disease, valvular heart disease, myocardial disease, cardiac dysrhythmia, and cerebrovascular disease). Heterogeneity was assessed using I 2 statistics and prediction intervals.ResultsOf the 7734 studies identified, 22 studies were included in this review, representing 32 438 HL and NHL survivors. Relative to the general population, lymphoma survivors had statistically significant two to threefold increases in the risk for nearly all subtypes of CVD examined. Lymphoma survivors appeared to be particularly susceptible to pericardial diseases (HL: 10.67, 95% confidence interval (CI), 7.75‐14.69; NHL: 4.70, 95% CI, 2.08‐10.61) and valvular diseases (HL: 13.10, 95% CI, 7.41‐23.16; NHL: 3.76, 95% CI, 2.12‐6.66). Although the 95% CIs were suggestive of increased risks, the 95% prediction intervals often included the null, reflecting the high heterogeneity of the estimates.ConclusionGiven the suggested increased risks of cardiovascular outcomes in lymphoma survivor populations relative to the general population, tailored screening and prevention programmes may be warranted to offset the future burden of disease.
Highlights
Hodgkin Lymphoma (HL) and non-Hodgkin Lymphoma (NHL) are solid tumours of the immune system common in both adults and children,[1] accounting for an estimated 79 990 and 509 590 cases of cancer worldwide in 2018, respectively.[2]
We hypothesized that long-term HL and NHL survivors will have an elevated risk of incident cardiovascular disease (CVD) events relative to the general population, and that the incidence would differ by type of CVD
Within HL survivors, there were statistically significant increased risks estimated for all seven CVD subtypes assessed relative to the general population, with the largest increases of risk seen for myocardial disease (MD) (3.95, 95% confidence interval (CI), 2.48-6.27; I2 = 97.1%), pericardial disease (PD) (10.67, 95% CI, 7.75-14.69; I2 = 63.3%), and valvular heart disease (VHD) (13.10, 95% CI, 7.41-23.16; I2 = 96.2%) (Table 2)
Summary
Hodgkin Lymphoma (HL) and non-Hodgkin Lymphoma (NHL) are solid tumours of the immune system common in both adults and children,[1] accounting for an estimated 79 990 and 509 590 cases of cancer worldwide in 2018, respectively.[2]. The long-term cardio-toxic effects of these treatments, especially chemotherapy regimens utilizing anthracyclines and radiation therapy, have become more apparent in cancer survivors over the past decade.[13-19]. It is possible that both the CVD incidence and mortality rates experienced by this survivor group relative to the general population are different because of cardio-toxic effects of treatment and damage to the cardiovascular system. Given that HL and NHL account for 3.2% of all cancers globally,[2,21] there is a need to quantify the long-term risk of CVD development among these survivors. No meta-analyses have previously examined the long-term risk of CVD incidence among HL and NHL survivors compared with the general population. We hypothesized that long-term HL and NHL survivors will have an elevated risk of incident CVD events relative to the general population, and that the incidence would differ by type of CVD
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