Long term survivors of childhood brain cancer have an increased risk for cardiovascular disease.
BACKGROUND
Cranial irradiation for children with brain tumors frequently leads to neuroendocrine deficiencies. In this controlled study, the authors investigated risk factors for cardiovascular disease (CVD) for long term survivors of childhood brain cancer. They also tested whether the presence of these risk factors was related to endocrine status.


METHODS
In 26 survivors of childhood brain cancer (mean age, 25.8 years; mean posttreatment interval, 16 years) and 29 healthy controls (mean age, 27.7 years), the blood pressure, smoking habits, body mass index (BMI), and waist/hip (W/H) ratio were determined. Lipids and lipoproteins were measured and endocrine function was assessed. Carotid intima-media thickness (IMT) measurements were performed by high resolution ultrasonography.


RESULTS
In the survivors of childhood brain cancer, systolic blood pressure and W/H ratio were elevated compared with controls. The cholesterol/high density lipoprotein ratio (4.7 +/- 1.7 vs. 3.4 +/- 0.8 mmol/L, P = 0.0005), low density lipoprotein cholesterol level (3.3 +/- 0.9 vs. 2.8 +/- 0.6 mmol/L, P = 0.027), and apolipoprotein B level (P = 0.001) were higher in survivors of childhood brain cancer, whereas HDL cholesterol was lower (P = 0.005). The IMT was increased in the survivor group, but only in the carotid bulb (0.63 mm +/- 1.6 vs. 0.53 mm +/- 1.1, P = 0.02), not in the internal or common carotid artery. In the absolute growth hormone deficient (GHD) population (n = 9), LDL cholesterol and apolipoprotein B levels were elevated and the W/H ratio was particularly increased compared with the other survivors of childhood brain cancer.


CONCLUSIONS
For long term survivors of brain cancer, the risk for CVD is strongly increased due to dyslipidemia, central obesity, and elevated systolic blood pressure, particularly for those with GHD. The first effects of this increased risk for CVD were observed in the carotic bulb, as assessed by IMT measurements. Efforts should be directed at CVD prevention by risk factor control.
Heikens
J
J
Wilhelmina Ziekenhuis, Assen, The Netherlands.
Ubbink
M C
MC
van der Pal
H P
HP
Bakker
P J
PJ
Fliers
E
E
Smilde
T J
TJ
Kastelein
J J
JJ
Trip
M D
MD
D000293:Adolescent; D000328:Adult; D001055:Apolipoproteins B / Q000097:blood; D001794:Blood Pressure; D001824:Body Constitution; D015992:Body Mass Index; D001932:Brain Neoplasms / Q000532:radiotherapy*; D002318:Cardiovascular Diseases / Q000209:etiology*; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D002648:Child; D002784:Cholesterol / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D016371:Cranial Irradiation / Q000009:adverse effects*; D004700:Endocrine System Diseases / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D019382:Human Growth Hormone / Q000172:deficiency; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009490:Neurosecretory Systems / Q000528:radiation effects; D012307:Risk Factors; D012907:Smoking; D017741:Survivors; D017539:Tunica Intima / Q000000981:diagnostic imaging; D017540:Tunica Media / Q000000981:diagnostic imaging; D014463:Ultrasonography
D001055:Apolipoproteins B; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D019382:Human Growth Hormone; D002784:Cholesterol