title: Long-term risk of cardiovascular disease after treatment for aggressive non-Hodgkin lymphoma.
abstract: Cardiovascular disease frequently occurs after lymphoma therapy, but it is common in the general population too. Therefore, risk estimation requires comparison to population-based rates. We calculated risk by standardized incidence ratios (SIRs) and absolute excess risks (AERs) per 10,000 person-years based on general population rates (Continuous Morbidity Registry Nijmegen) in 476 (Dutch and Belgian) patients with aggressive non-Hodgkin lymphoma (NHL) treated with at least 6 cycles of doxorubicin-based chemotherapy in 4 European Organization for Research on Treatment of Cancer (EORTC) trials (1980-1999). Cumulative incidence of cardiovascular disease, estimated in a competing risk model, was 12% at 5 years and 22% at 10 years (median follow-up, 8.4 years). Risk of chronic heart failure appeared markedly increased (SIR, 5.4; 95% CI, 4.1-6.9) with an AER of 208 excess cases per 10 000 person-years, whereas risk of coronary artery disease matched the general population (SIR, 1.2; 95% CI, 0.8-1.8; AER, 8 per 10 000 person-years). Risk of stroke was raised (SIR, 1.8; 95% CI, 1.1-2.4; AER, 15 per 10 000 person-years), especially after additional radiotherapy (> 40 Gy). Preexisting hypertension, NHL at young age, and salvage treatment increased risk of all cardiovascular events; the effect of radiotherapy was dose dependent. In conclusion, patients are at long-term high risk of chronic heart failure after NHL treatment and need therefore life-long monitoring. In contrast, risk of coronary artery disease appeared more age dependent than treatment related.
authors.affiliation: European Organization for Research on Treatment of Cancer (EORTC) Data Center, Brussels, Belgium. e.c.moser@lumc.nl
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Moser
authors.forename: Evert M
authors.initials: EM
authors.lastname: Noordijk
authors.forename: Flora E
authors.initials: FE
authors.lastname: van Leeuwen
authors.forename: Saskia
authors.initials: S
authors.lastname: le Cessie
authors.forename: Joke W
authors.initials: JW
authors.lastname: Baars
authors.forename: José
authors.initials: J
authors.lastname: Thomas
authors.forename: Patrice
authors.initials: P
authors.lastname: Carde
authors.forename: Jacobus H
authors.initials: JH
authors.lastname: Meerwaldt
authors.forename: Martine
authors.initials: M
authors.lastname: van Glabbeke
authors.forename: Hanneke C
authors.initials: HC
authors.lastname: Kluin-Nelemans
mesh_terms: D002318:Cardiovascular Diseases / Q000209:etiology*; D015331:Cohort Studies; D003327:Coronary Disease / Q000453:epidemiology; D016208:Databases, Factual; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008228:Lymphoma, Non-Hodgkin / Q000150:complications* / Q000532:radiotherapy; D009426:Netherlands / Q000453:epidemiology; D011878:Radiotherapy / Q000009:adverse effects; D012189:Retrospective Studies; D018570:Risk Assessment; D020521:Stroke / Q000453:epidemiology; D013997:Time Factors