Metabolic syndrome and cardiovascular risk among long-term survivors of acute lymphoblastic leukaemia - From the St. Jude Lifetime Cohort.
Adult survivors of childhood acute lymphoblastic leukaemia (ALL) have a four-fold excess risk of mortality from cardiovascular disease. This cardiovascular risk has not been fully characterized. ALL survivors [n = 784, median age 31·7 years (18·9-59·1)] in the St. Jude Lifetime Cohort Study underwent evaluation for cardiovascular risk and metabolic syndrome (MetS) according to National Cholesterol Education Program - Adult Treatment Panel III criteria. Comparisons were made to 777 age-, sex-, and race-matched controls from the National Health and Nutrition Examination Survey (NHANES). MetS was identified in 259 survivors (33·6%) and associated with older age in 5-year increments (relative risk [RR] 1·13, 95% confidence interval [CI] 1·06-1·19) and prior cranial radiotherapy (CRT) (with craniospinal radiation: RR 1·88, 95%CI 1·32-2·67; without: RR 1·67, 95%CI 1·26-2·23). Measures of obesity were highly prevalent among female survivors and CRT recipients. Compared to NHANES controls, ALL survivors had a higher risk of MetS (RR 1·43, 95%CI 1·22-1·69), hypertension (RR 2·43, 95%CI 2·06-2·86), low high-density lipoprotein (RR 1·40, 95%CI 1·23-1·59), obesity (RR 1·47, 95%CI 1·29-1·68) and insulin resistance (1·64, 95%CI 1·44-1·86). This large study of clinically evaluated ALL survivors identified a high prevalence of MetS, obesity and cardiovascular risk, particularly in CRT recipients, underscoring the need for screening and aggressive reduction of modifiable risks.
Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN, USA.
Kerri A
KA
Nottage
Kirsten K
KK
Ness
Chenghong
C
Li
Deokumar
D
Srivastava
Leslie L
LL
Robison
Melissa M
MM
Hudson
D000293:Adolescent; D000328:Adult; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications / Q000453:epidemiology* / Q000473:pathology; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000453:epidemiology* / Q000378:metabolism; D012307:Risk Factors; D017741:Survivors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
acute lymphoblastic leukaemia; cardiovascular risk; childhood cancer survivors; cranial radiotherapy; metabolic syndrome