title: Cardiovascular risk in long-term survivors of testicular cancer.
abstract: BACKGROUND
  Long-term survivors of testicular cancer (TC) who received cisplatin-based chemotherapy have an increased risk of cardiovascular disease. A cross-sectional study was performed to objectively assess cardiovascular risk, subclinical atherosclerosis, and endothelial function in long-term survivors of TC.
  
  
  METHODS
  Long-term survivors of TC underwent evaluation including determination of body mass index (BMI), Framingham relative risk (RR), brachial artery flow-mediated dilatation (FMD), carotid artery intima-media thickness (IMT), soluble intercellular adhesion molecule-1 (sICAM-1), high sensitivity C-reactive protein (hs-CRP), and flow cytometric analysis of peripheral blood for levels of endothelial progenitor cells (EPCs) and circulating endothelial cells (CECs). TC survivors who received chemotherapy were compared with a chemotherapy naive cohort.
  
  
  RESULTS
  Twenty-four patients received cisplatin-based chemotherapy (CBCT) and 15 were chemotherapy-naive (CN). The CBCT cohort demonstrated more impairment of brachial artery FMD than the CN group (5.6% vs 8.8%; P = .05). The mean sICAM was also found to be higher in the CBCT cohort compared with the CN group (P = .04). No significant differences between the groups were noted with regard to BMI, Framingham RR, carotid IMT, or hs-CRP. In a subset of patients, TC survivors who received chemotherapy had a significantly increased level of CECs compared with CN patients (P = .04). No significant difference in EPC levels was detected.
  
  
  CONCLUSIONS
  Long-term survivors of TC who received chemotherapy demonstrate objective evidence of endothelial injury and dysfunction, a potential mechanism for increased cardiovascular risk.
authors.affiliation: Department of Medicine, Hematology/Oncology Division, University of Pennsylvania, Philadelphia, PA 19104, USA. david.vaughn@uphs.upenn.edu
authors.forename: David J
authors.initials: DJ
authors.lastname: Vaughn
authors.forename: Steven C
authors.initials: SC
authors.lastname: Palmer
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Carver
authors.forename: Linda A
authors.initials: LA
authors.lastname: Jacobs
authors.forename: Emile R
authors.initials: ER
authors.lastname: Mohler
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects*; D050197:Atherosclerosis / Q000209:etiology; D002318:Cardiovascular Diseases / Q000209:etiology*; D002945:Cisplatin / Q000009:adverse effects*; D003324:Coronary Artery Disease / Q000209:etiology; D042783:Endothelial Cells / Q000502:physiology; D006801:Humans; D008297:Male; D012307:Risk Factors; D017741:Survivors; D013736:Testicular Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000401:mortality
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin