title: Insulin resistance and risk factors for cardiovascular disease in young adult survivors of childhood acute lymphoblastic leukemia.
abstract: OBJECTIVE
  To determine the prevalence of insulin resistance and other risk factors for cardiovascular disease (CVD) in young adult survivors of childhood acute lymphoblastic leukemia (ALL).
  
  
  METHODS
  In this cross-sectional evaluation of 118 survivors of childhood ALL (median age, 23.0 years; range, 18 to 37 years), insulin resistance was estimated using the homeostasis model for assessment of insulin resistance (HOMA-IR). Sex-specific comparisons were made with a cohort of 30- to 37-year-old individuals from the same region participating in the Dallas Heart Study (DHS, N = 782). ALL survivors were stratified by treatment with and without cranial radiotherapy (CRT).
  
  
  RESULTS
  Female ALL survivors had a significantly higher HOMA-IR (CRT, mean 4.6, 95% CI, 3.6 to 5.7; no CRT, mean 3.3, 95% CI, 2.8 to 3.8) in comparison with DHS women (mean 2.4, 95% CI, 2.2 to 2.7). Eighty percent of women treated with CRT had at least three of six CVD risk factors, and they were significantly more likely to have three or more risk factors compared with DHS women (odds ratio [OR], 5.96; 95% CI, 2.15 to 16.47). Male ALL survivors had a significantly higher HOMA-IR (CRT, mean 4.0, 95% CI, 2.8 to 5.6; no CRT, mean 3.4, 95% CI, 2.9 to 3.9) in comparison with DHS men (mean 2.3, 95% CI, 2.1 to 2.6), but were not more likely to have multiple CVD risk factors.
  
  
  CONCLUSIONS
  ALL survivors had an increased prevalence of insulin resistance in comparison with a cohort of older individuals from the same community. Importantly, women treated with CRT seem to have an increased prevalence of multiple CVD risk factors, warranting close monitoring and risk-reducing strategies.
authors: Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021, USA. oeffingk@mskcc.org
authors: Kevin C
authors: KC
authors: Oeffinger
authors: Beverley
authors: B
authors: Adams-Huet
authors: Ronald G
authors: RG
authors: Victor
authors: Timothy S
authors: TS
authors: Church
authors: Peter G
authors: PG
authors: Snell
authors: Andrea L
authors: AL
authors: Dunn
authors: Debra A
authors: DA
authors: Eshelman-Kent
authors: Robert
authors: R
authors: Ross
authors: Peter M
authors: PM
authors: Janiszewski
authors: Alicia J
authors: AJ
authors: Turoff
authors: Sandra
authors: S
authors: Brooks
authors: Gloria Lena
authors: GL
authors: Vega
mesh_terms: D000328:Adult; D017668:Age of Onset; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects*; D001786:Blood Glucose / Q000032:analysis; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D016001:Confidence Intervals; D016371:Cranial Irradiation / Q000009:adverse effects* / Q000379:methods; D003430:Cross-Sectional Studies; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007333:Insulin Resistance / Q000528:radiation effects*; D008297:Male; D009367:Neoplasm Staging; D016017:Odds Ratio; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D015995:Prevalence; D012307:Risk Factors; D016019:Survival Analysis; D017741:Survivors / Q000706:statistics & numerical data; D013997:Time Factors; D055815:Young Adult
chemical_list: D001786:Blood Glucose