Cardiovascular family history increases risk for late-onset adverse cardiovascular outcomes in childhood cancer survivors: A St. Jude lifetime cohort report

Jason F. Goldberg, Kirsten K. Ness, Xiaofei Chi, Aimee K. Santucci, Juan Carlos Plana, Vijaya M. Joshi, Russell V. Luepker, Jean Bernard Durand, Robyn E. Partin, Rebecca M. Howell, Carmen L. Wilson, Jeffrey A. Towbin, John L. Jefferies, Deo Kumar Srivastava, Melissa M. Hudson, Leslie L. Robison, Gregory T. Armstrong

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Survivors of childhood cancer have an increased risk of therapy-related cardiovascular disease. It is not known whether family history of cardiovascular disease further increases risk of adverse cardiovascular outcomes among survivors. Methods: Family history of cardiovascular disease was collected from 1,260 survivors [median age at diagnosis, 8 years (range, 0-23); age at last follow-up, 35 years (range, 18-66)] of childhood cancer in the St. Jude Lifetime Cohort Study. Multivariable risk models evaluated associations with cardiovascular disease (Common Terminology Criteria for Adverse Events grade 2-4 events) and cardiovascular risk factors. Results: Among survivors exposed to chest-directed radiation and/or anthracycline chemotherapy (n = 824), 7% reported a firstdegree family history of heart failure, 19% myocardial infarction, 11% stroke, 26% atherosclerotic disease (myocardial infarction and/ or stroke), 62% hypertension, and 31% diabetes mellitus. Eighteen percent of exposed survivors developed heart failure, 9% myocardial infarction, 3% stroke, 11% atherosclerotic disease, 30% hypertension, and 9% diabetes mellitus. Having a first-degree family history of atherosclerotic disease was independently associated with development of treatment-related heart failure [RR, 1.38; 95% confidence interval (CI), 1.01-1.88; P = 0.04] among exposed survivors. Risk for hypertension was increased among exposed survivors with a first-degree family history of hypertension (RR, 1.55; 95% CI, 1.26-1.92; P < 0.0001) or of any cardiovascular disease [myocardial infarction, stroke, or heart failure (RR, 1.30; 95% CI, 1.06-1.59; P = 0.01)]. Conclusions: Family history of cardiovascular disease and cardiovascular risk factors independently increased risk of heart failure and hypertension among survivors of childhood cancer exposed to cardiotoxic therapies. Impact: These data show the importance of cardiovascular family history as a risk factor for cardiovascular disease in survivors of childhood cancer.

Original languageEnglish (US)
Pages (from-to)123-132
Number of pages10
JournalCancer Epidemiology Biomarkers and Prevention
Volume30
Issue number1
DOIs
StatePublished - Jan 2021

Bibliographical note

Funding Information:
K.K. Ness reports grants from NIH during the conduct of the study. R.V. Luepker reports grants from NIH-government during the conduct of the study. R.E. Partin reports grants from NCI and Cancer Center Support (CORE) during the conduct of the study. R.M. Howell reports grants from St. Jude Research Hospital (research group has received funding for dosimetry for the SJLIFE cohort) during the conduct of the study. M.M. Hudson reports grants from NCI (U01CA195547) during the conduct of the study. L.L. Robison reports grants from NIH during the conduct of the study. G.T. Armstrong reports grants from NCI during the conduct of the study. No disclosures were reported by the other authors.

Publisher Copyright:
© 2020 American Association for Cancer Research.

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural

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