title: Predicted cardiovascular mortality and reported cardiovascular morbidity in testicular cancer survivors.
abstract: BACKGROUND
  We examined if testicular cancer (TC) treatment is associated with any risk for cardiovascular morbidity or predicted mortality according to the SCORE model, in which a 10-year future risk of >or=5% for developing a fatal cardiovascular event qualify for high-risk status.
  
  
  METHODS
  One thousand one hundred thirty-four TC survivors treated 1980-1994 participated in this study (1998-2002). Patients were categorised in four treatment groups: surgery (n = 225), radiotherapy (n = 445), and two chemotherapy groups: cumulative cisplatin dose <or=850 mg (n = 375) and >850 mg (cis>850, n = 89). Patients with cardiovascular disease, diabetes or SCORE >or=5% constituted a high-risk group, and those with SCORE >1% an intermediate/high risk group.
  
  
  RESULTS
  Age-adjusted mean SCORE was 0.93% for the surgery group. In comparison, chemotherapy treated patients had significantly higher SCORE (1.07%, p = 0.01). Only 15% of patients were scored to be at high-risk, while 53% qualified for the intermediate/high risk group. Patients in the cis>850 group had increased odds for having intermediate/high risk, compared with the surgery group (OR 3.4, 95% CI 1.3-8.7). Only 23 cardiovascular events had occurred since the testicular cancer diagnosis.
  
  
  CONCLUSIONS
  The SCORE model indicates that patients treated with cisplatin-based chemotherapy have a significantly increased future risk of a fatal cardiovascular event.
  
  
  CONCLUSIONS
  TC survivors should be followed regularly with respect to cardiovascular risk profile beyond the routine 10-year clinical follow-up.
authors.affiliation: Department of Oncology, Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway. hegesa@fagmed.uit.no
authors.forename: H S
authors.initials: HS
authors.lastname: Haugnes
authors.forename: N
authors.initials: N
authors.lastname: Aass
authors.forename: S D
authors.initials: SD
authors.lastname: Fosså
authors.forename: O
authors.initials: O
authors.lastname: Dahl
authors.forename: O
authors.initials: O
authors.lastname: Klepp
authors.forename: E A
authors.initials: EA
authors.lastname: Wist
authors.forename: T
authors.initials: T
authors.lastname: Wilsgaard
authors.forename: R M
authors.initials: RM
authors.lastname: Bremnes
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D002277:Carcinoma / Q000453:epidemiology* / Q000628:therapy; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality*; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D015331:Cohort Studies; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012107:Research Design; D018570:Risk Assessment; D018239:Seminoma / Q000453:epidemiology* / Q000628:therapy; D017741:Survivors / Q000706:statistics & numerical data*; D013736:Testicular Neoplasms / Q000453:epidemiology* / Q000628:therapy; D055815:Young Adult
chemical_list: D002945:Cisplatin
references.citation: Am Heart J. 1991 Jan;121(1 Pt 2):293-8
references.pmid: 1985385
references.citation: J Clin Oncol. 2004 Feb 15;22(4):640-7
references.pmid: 14726503
references.citation: Eur Urol. 2003 Sep;44(3):322-8
references.pmid: 12932930
references.citation: Ann Oncol. 2002 Feb;13(2):229-36
references.pmid: 11885999
references.citation: Eur Heart J. 2005 Dec;26(24):2673-80
references.pmid: 16204260
references.citation: J Natl Cancer Inst. 2005 Nov 2;97(21):1580-8
references.pmid: 16264178
references.citation: Br J Cancer. 1995 Mar;71(3):619-24
references.pmid: 7880748
references.citation: J Clin Oncol. 2006 Jan 20;24(3):467-75
references.pmid: 16421423
references.citation: Int J Epidemiol. 2004 Apr;33(2):235-9
references.pmid: 15082618
references.citation: Eur Urol. 2008 Mar;53(3):478-96
references.pmid: 18191324
references.citation: J Clin Oncol. 1990 Jan;8(1):21-6
references.pmid: 1688614
references.citation: Circulation. 1983 May;67(5):968-77
references.pmid: 6219830
references.citation: Lancet. 1979 Aug 11;2(8137):267-70
references.pmid: 88606
references.citation: Eur J Cardiovasc Prev Rehabil. 2007 Sep;14 Suppl 2:E1-40
references.pmid: 17726406
references.citation: Int J Radiat Oncol Biol Phys. 1992;24(5):913-9
references.pmid: 1447034
references.citation: J Cancer Surviv. 2007 Mar;1(1):8-16
references.pmid: 18648940
references.citation: J Clin Oncol. 2000 Apr;18(8):1725-32
references.pmid: 10764433
references.citation: J Clin Oncol. 2003 Apr 15;21(8):1513-23
references.pmid: 12697875
references.citation: Circulation. 1991 Jan;83(1):356-62
references.pmid: 1984895
references.citation: Eur J Endocrinol. 2003 Aug;149(2):145-52
references.pmid: 12887292
references.citation: Eur J Cancer. 2004 Mar;40(5):701-6
references.pmid: 15010071
references.citation: Eur Heart J. 2003 Jun;24(11):987-1003
references.pmid: 12788299
references.citation: Eur J Cancer. 1997 Jun;33(7):1038-44
references.pmid: 9376184
references.citation: Lancet. 1999 May 8;353(9164):1547-57
references.pmid: 10334252
references.citation: Cancer. 1987 Aug 15;60(4):772-6
references.pmid: 3594400
references.citation: BMJ. 2003 Nov 29;327(7426):1267
references.pmid: 14644971
references.citation: Br J Cancer. 2000 Dec;83(12):1623-9
references.pmid: 11104556
references.citation: J Clin Oncol. 1999 Apr;17(4):1146
references.pmid: 10561173
references.citation: Circulation. 2007 Dec 4;116(23):2694-701
references.pmid: 18040028
references.citation: J Clin Oncol. 2005 Aug 1;23(22):4980-90
references.pmid: 16051950
references.citation: J Clin Oncol. 2005 Jun 1;23(16):3718-25
references.pmid: 15738540
references.citation: Eur J Endocrinol. 2004 Jan;150(1):65-71
references.pmid: 14713281
references.citation: Ann Oncol. 2007 Feb;18(2):241-8
references.pmid: 17060482
references.citation: J Natl Cancer Inst. 2007 Apr 4;99(7):533-44
references.pmid: 17405998
references.citation: J Clin Oncol. 1990 Mar;8(3):509-18
references.pmid: 1689773
references.citation: Eur Heart J. 2003 Sep;24(17):1601-10
references.pmid: 12964575
references.citation: J Clin Oncol. 1996 Apr;14(4):1106-13
references.pmid: 8648364
references.citation: Diabetes Care. 2004 May;27(5):1036-41
references.pmid: 15111517
references.citation: J Clin Oncol. 1997 May;15(5):1844-52
references.pmid: 9164194
references.citation: Eur Heart J. 2003 May;24(10):937-45
references.pmid: 12714025
references.citation: J Clin Endocrinol Metab. 2008 Jan;93(1):68-75
references.pmid: 17911176
references.citation: J Clin Oncol. 1991 May;9(5):818-26
references.pmid: 1707957
references.citation: BMJ. 2005 Sep 10;331(7516):551
references.pmid: 16103030
references.citation: Am J Med. 2004 Aug 15;117(4):219-27
references.pmid: 15308430
references.citation: Ann Intern Med. 1992 May 1;116(9):709-15
references.pmid: 1558341