Atherosclerotic lesions in lymphoma survivors treated with radiotherapy.
OBJECTIVE
Radiotherapy causes premature atherosclerosis in Hodgkin's lymphoma survivors (HLSs). We determined whether atherosclerosis within the radiation field was predicted by traditional risk factors independent of radiation and compared the extent of atherosclerosis in HLSs treated with mantle field radiotherapy with non-irradiated patients.


METHODS
Forty-three HLSs (median age 50 years, range 38-63) treated with mantle field radiotherapy were included. Cardiovascular risk factors were registered at first follow-up (FU-1) 5-13 years after treatment. A second follow-up (FU-2) occurred 18-27 years after treatment. At FU-2, in-field atherosclerosis was assessed by computed tomography with calculation of coronary artery calcium volume score (CACS) and pre-cranial artery atherosclerosis score (PAS). Peripheral endothelial dysfunction was assessed by ante-brachial strain-gauge plethysmography. CT angiography of pre-cranial vessels was also performed in 43 non-irradiated patients.


RESULTS
Multiple linear regression analyses showed that cholesterol at FU-1 was a predictor of CACS (β 308 (95% CI 213-403), p < 0.001), PAS (β 3.67 (95% CI 2.29-5.04), p < 0.001) and peripheral endothelial dysfunction (β 2.74 (95% CI 0.47-5.01), p = 0.02). There were more atherosclerotic lesions in HLSs (n = 141) than in non-irradiated patients (n = 73, p = 0.001).


CONCLUSIONS
Irradiated arteries are characterized by widespread atherosclerotic lesions aggravated by elevated levels of cholesterol.
Department of Cardiology, University of Oslo, and Department of Medicine, Trondheim University Hospital, Norway. Electronic address: torgeir.wethal@medisin.uio.no.
Torgeir
T
Wethal
Department of Radiology, Oslo University Hospital, Oslo, Norway.
Bård
B
Nedregaard
Department of Radiology, Oslo University Hospital, Oslo, Norway.
Rune
R
Andersen
Cancer Clinic, The Norwegian Radium Hospital, Oslo, Norway.
Alexander
A
Fosså
Department of Respiratory Medicine, Oslo University Hospital, University of Oslo, Norway.
May Brit
MB
Lund
Department of Radiology, Oslo University Hospital, Oslo, Norway.
Anne
A
Günther
Cancer Clinic, The Norwegian Radium Hospital, Oslo, Norway.
Stein
S
Kvaløy
Department of Clinical Cancer Research, University of Oslo, Norway.
Sophie D
SD
Fosså
Department of Cardiology, University of Oslo, and Department of Medicine, Trondheim University Hospital, Norway.
John
J
Kjekshus
D000293:Adolescent; D000328:Adult; D050197:Atherosclerosis / Q000209:etiology*; D002318:Cardiovascular Diseases / Q000209:etiology; D002784:Cholesterol / Q000097:blood; D003324:Coronary Artery Disease / Q000209:etiology; D004730:Endothelium, Vascular / Q000528:radiation effects; D005260:Female; D006689:Hodgkin Disease / Q000401:mortality / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D017741:Survivors; D061205:Vascular Calcification / Q000209:etiology
D002784:Cholesterol
Atherosclerosis; CT; Pre-cranial arteries; Radiotherapy