title: Cardiovascular disease as a long-term complication of treatment for testicular cancer.
abstract: OBJECTIVE
  To assess the risk of cardiovascular morbidity and cardiac risk factors in long-term survivors of testicular cancer according to treatment received.
  
  
  METHODS
  All resident male patients registered in the United Kingdom between 1982 and 1992 attending for follow-up were eligible for recruitment. Patients completed a current health questionnaire and underwent clinical review, along with hematologic, biochemical, and hormonal profiles. For patients not under routine review, follow-up information was sought from their general practitioner and mortality data were sought from the Office of National Statistics. Descriptive analysis was performed on all variables and comparisons were made among patients treated by orchidectomy and follow-up only, chemotherapy alone (C), radiotherapy alone (RT), and radiotherapy and chemotherapy (C/RT).
  
  
  RESULTS
  Data on cardiovascular events were available on 992 patients. After a median follow-up of 10.2 years, 68 events had been reported, including 18 deaths. After adjusting for age, increased risk for cardiac events was seen after C (relative risk [RR] = 2.59; 95% confidence interval [CI], 1.15 to 5.84; P =.022), RT (RR = 2.40; 95% CI, 1.04 to 5.45; P =.036), and C/RT (RR = 2.78; 95% CI, 1.09 to 7.07; P =.032). There were no significant differences in cardiac risk factors. On multivariate analysis, age, treatment group, free thyroxine, protein, and magnesium levels were associated with cardiovascular disease.
  
  
  CONCLUSIONS
  In long-term survivors of testicular cancer, we observed a two-fold or greater risk of developing cardiovascular disease. This was not due to increases in cardiac risk factors, which suggests a direct or indirect treatment effect. These data support the continued research into the minimization of treatment in good-prognosis testicular cancer.
authors.affiliation: Academic Unit of Radiotherapy and Oncology, Royal Marsden NHS Trust and Institute of Cancer Research, Downs Rd, Sutton, Surrey SM2 5PT, United Kingdom. roberth@icr.ac.uk
authors.forename: R A
authors.initials: RA
authors.lastname: Huddart
authors.forename: A
authors.initials: A
authors.lastname: Norman
authors.forename: M
authors.initials: M
authors.lastname: Shahidi
authors.forename: A
authors.initials: A
authors.lastname: Horwich
authors.forename: D
authors.initials: D
authors.lastname: Coward
authors.forename: J
authors.initials: J
authors.lastname: Nicholls
authors.forename: D P
authors.initials: DP
authors.lastname: Dearnaley
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D002318:Cardiovascular Diseases / Q000097:blood / Q000209:etiology*; D003430:Cross-Sectional Studies; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013736:Testicular Neoplasms / Q000097:blood / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D013997:Time Factors; D006113:United Kingdom