title: Signs of early sub-clinical atherosclerosis in childhood cancer survivors.
abstract: BACKGROUND
  Cancer is the leading cause of death by disease among U.S. children ages 1-14 years; however, over the last few decades there has been a dramatic increase in survival in these individuals. Although free of cancer, survivors are faced with a variety of chronic health problems including an increased risk of cardiovascular and metabolic abnormalities. The effect of cancer treatments on vascular structure and function in childhood cancer survivors (CCS) has not been examined.
  
  
  METHODS
  Measures of carotid artery stiffness (compliance and distensibility) and thickness (IMT), brachial artery endothelial-dependent dilation (EDD), and endothelial-independent dilation (EID) were obtained from ultrasound imaging in 319 CCS (age: 14.6 ± 0.1 years; male/female: 112/96) who were >5 years from diagnosis and 208 (age: 13.6 ± 0.2 years; male/female: 171/148) siblings who had never been diagnosed with cancer. Participants were 9-18 years of age at examination.
  
  
  RESULTS
  Survivors of leukemia had lower carotid distensibility and compliance, indicating increased arterial stiffness, when compared to controls. There were no significant differences in measures of carotid stiffness or EDD in survivors of solid tumors and central nervous system (CNS) tumors compared to controls. EDD was lower in leukemia survivors than in controls, and EID was greater in survivors of CNS tumors than in controls.
  
  
  CONCLUSIONS
  These results demonstrate that early in life, CCS have arterial changes indicating increased risk for premature atherosclerosis and cardiovascular disease. Therefore, it is reasonable to advocate that efforts should be directed at monitoring and managing cardiovascular risk factors in CCS.
authors.affiliation: School of Kinesiology, University of Minnesota, Minneapolis, Minnesota, 55455; Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota, 55455.
authors.forename: Donald R
authors.initials: DR
authors.lastname: Dengel
authors.forename: Aaron S
authors.initials: AS
authors.lastname: Kelly
authors.forename: Lei
authors.initials: L
authors.lastname: Zhang
authors.forename: James S
authors.initials: JS
authors.lastname: Hodges
authors.forename: K Scott
authors.initials: KS
authors.lastname: Baker
authors.forename: Julia
authors.initials: J
authors.lastname: Steinberger
mesh_terms: D000293:Adolescent; D050197:Atherosclerosis / Q000209:etiology* / Q000503:physiopathology; D001916:Brachial Artery / Q000503:physiopathology; D001932:Brain Neoplasms / Q000150:complications; D002339:Carotid Arteries / Q000503:physiopathology; D002648:Child; D004730:Endothelium, Vascular / Q000503:physiopathology; D005260:Female; D006801:Humans; D007938:Leukemia / Q000150:complications; D008297:Male; D009369:Neoplasms / Q000150:complications* / Q000401:mortality / Q000628:therapy; D017741:Survivors; D059289:Vascular Stiffness
keywords: cancer survivors; children; compliance; distensibility; ultrasound