title: Cardiovascular risk factors and morbidity in long-term survivors of testicular cancer: a 20-year follow-up study.
abstract: OBJECTIVE
  To evaluate the prevalence of cardiovascular risk factors and long-term incidence of cardiovascular disease (CVD) in survivors of testicular cancer (TC).
  
  
  METHODS
  Overall, 990 men treated for unilateral TC (1980 to 1994) were included in this national follow-up study (2007 to 2008). They were categorized into four treatment groups: surgery (n = 206), radiotherapy only (RT; n = 386), chemotherapy only (n = 364), and combined RT/chemotherapy (n = 34). Age-matched male controls from the general population (ie, NORMs) were included (n = 990). Survivors of TC who were diagnosed with CVD before or within 2 years after the TC diagnosis were excluded from analyses of CVD end points.
  
  
  RESULTS
  Median observation time was 19 years (range, 13 to 28 years). All cytotoxic treatment groups had significantly increased prevalences of antihypertensive medication, and survivors in the RT and RT/chemotherapy groups had higher prevalences of diabetes (RT: odds ratio [OR], 2.3; 95% CI, 1.5 to 3.7; RT/chemotherapy: OR, 3.9; 95% CI, 1.4 to 10.9) compared with NORMs. Overall 74 survivors of TC (8.0%) experienced atherosclerotic disease during follow-up. Increased risks for atherosclerotic disease were observed in age-adjusted Cox regression analyses after any cytotoxic treatment when compared with surgery only (RT: hazard ratio [HR], 2.3; 95% CI, 1.04 to 5.3; chemotherapy: HR, 2.6; 95% CI, 1.1 to 5.9; RT/chemotherapy: HR, 4.8; 95% CI, 1.6 to 14.4). Treatment with cisplatin, bleomycin, and etoposide (BEP) alone had a 5.7-fold higher risk (95% CI, 1.9 to 17.1 fold) for coronary artery disease compared with surgery only and a 3.1-fold higher risk (95% CI, 1.2 to 7.7 fold) for myocardial infarction compared with NORMs.
  
  
  CONCLUSIONS
  Treatment with infradiaphragmatic RT and/or cisplatin-based chemotherapy, particularly the BEP regimen, increases the long-term risk for CVD in survivors of TC.
authors.affiliation: Department of Oncology, Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway. hege.sagstuen.haugnes@uit.no
authors.forename: Hege S
authors.initials: HS
authors.lastname: Haugnes
authors.forename: Torgeir
authors.initials: T
authors.lastname: Wethal
authors.forename: Nina
authors.initials: N
authors.lastname: Aass
authors.forename: Olav
authors.initials: O
authors.lastname: Dahl
authors.forename: Olbjørn
authors.initials: O
authors.lastname: Klepp
authors.forename: Carl W
authors.initials: CW
authors.lastname: Langberg
authors.forename: Tom
authors.initials: T
authors.lastname: Wilsgaard
authors.forename: Roy M
authors.initials: RM
authors.lastname: Bremnes
authors.forename: Sophie D
authors.initials: SD
authors.lastname: Fosså
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology; D016022:Case-Control Studies; D017024:Chemotherapy, Adjuvant; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D016017:Odds Ratio; D015995:Prevalence; D016016:Proportional Hazards Models; D011832:Radiation Injuries / Q000453:epidemiology* / Q000209:etiology; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D018570:Risk Assessment; D012307:Risk Factors; D017741:Survivors / Q000706:statistics & numerical data*; D013736:Testicular Neoplasms / Q000453:epidemiology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D013521:Urologic Surgical Procedures, Male / Q000009:adverse effects*; D055815:Young Adult