title: Cardiovascular risk factors in hematopoietic cell transplantation survivors: role in development of subsequent cardiovascular disease.
abstract: Hematopoietic cell transplantation (HCT) recipients may be at an increased risk of developing hypertension, diabetes, and dyslipidemia (referred to as cardiovascular risk factors [CVRFs]); and these factors can potentially increase the risk of cardiovascular disease (CVD). We examined the incidence and predictors of CVRFs and subsequent CVD in 1885 consecutive 1+year survivors of HCT performed at City of Hope between 1995 and 2004. Ten-year cumulative incidence of hypertension, diabetes, dyslipidemia, and multiple (≥ 2) CVRFs was 37.7%, 18.1%, 46.7%, and 31.4%, respectively. The prevalence of CVRFs was significantly higher among HCT recipients compared with the general population; contributed to largely by allogeneic HCT recipients. Older age and obesity at HCT were associated with increased risk of CVRFs. History of grade II-IV acute graft versus host disease was associated with an increased risk for hypertension (relative risk [RR] = 9.1, P < .01), diabetes (RR = 5.8, P < .01), and dyslipidemia (RR = 3.2, P < .01); conditioning with total body irradiation was associated with an increased risk of diabetes (RR = 1.5, P = .01) and dyslipidemia (RR = 1.4, P < .01). There was an incremental increase in 10-year incidence of CVD by number of CVRFs (4.7% [none], 7.0% [1 CVRF], 11.2% [≥ 2 CVRFs], P < .01); the risk was especially high (15.0%) in patients with multiple CVRFs and pre-HCT exposure to anthracyclines or chest radiation.
authors.affiliation: Department of Population Sciences, City of Hope, 1500 E. Duarte Rd, Duarte, CA 91010-3000, USA. sarmenian@coh.org
authors.forename: Saro H
authors.initials: SH
authors.lastname: Armenian
authors.forename: Can-Lan
authors.initials: CL
authors.lastname: Sun
authors.forename: Tabitha
authors.initials: T
authors.lastname: Vase
authors.forename: Kirsten K
authors.initials: KK
authors.lastname: Ness
authors.forename: Emily
authors.initials: E
authors.lastname: Blum
authors.forename: Liton
authors.initials: L
authors.lastname: Francisco
authors.forename: Kalyanasundaram
authors.initials: K
authors.lastname: Venkataraman
authors.forename: Raynald
authors.initials: R
authors.lastname: Samoa
authors.forename: F Lennie
authors.initials: FL
authors.lastname: Wong
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Forman
authors.forename: Smita
authors.initials: S
authors.lastname: Bhatia
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018943:Anthracyclines / Q000009:adverse effects; D002140:California / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000209:etiology; D050171:Dyslipidemias / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006086:Graft vs Host Disease / Q000453:epidemiology / Q000209:etiology*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000209:etiology; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D013902:Radiography, Thoracic / Q000009:adverse effects; D018570:Risk Assessment; D012307:Risk Factors; D017741:Survivors / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D018943:Anthracyclines