title: Prevalence of cardiovascular risk factors in long-term survivors of childhood cancer: 16 years follow up from a prospective registry.
abstract: BACKGROUND
  Childhood cancer survivors (CCSs) have an increased risk of overweight and dyslipidaemia, but the distribution and the potential relationships between anticancer therapies and cardiovascular risk factors have been heterogeneously and not prospectively described.
  
  
  METHODS
  All consecutive CCSs with primary cancer diagnosed between 1973-2007 and subsequently referred to our outpatient clinic were enrolled. Hypercholesterolaemia (total cholesterol >200 and/or low density lipoprotein (LDL)>160 mg/dl) was the primary end point, hypertriglyceridaemia (triglycerides >200 mg/dl) and body mass index >30 kg/m(2) the secondary end points. Cox multivariate adjustments were performed to account for differences in cancer and treatments.
  
  
  RESULTS
  A total of 340 patients were included (197 male, 143 female; mean age at last follow-up 24.1 ± 3.2). The most common diagnosis were haematological malignancies (n = 227) and brain tumours (n = 51). After a median follow-up of 16.1 years, hypercholesterolaemia was diagnosed in 67 CCSs (20%), hypertriglyceridaemia in 20 CCSs (6%) and obesity in 28 CCSs (8%). Total body irradiation and growth hormone deficiency increased the risk of both hypercholesterolaemia (hazard ratio (HR) = 2.7; confidence interval (CI) 1.2-4.4 and HR = 2.3; CI 1.1-4.9; all p < 0.05) and hypertriglyceridaemia (HR = 6.5; CI 1.4-31 and HR = 7.2; CI 1.1-43; all p < 0.05). The risk of hypercholesterolaemia was also higher in CCSs who underwent autologous haematopoietic stem cell transplantation (HR = 3.2; CI 1.7-5.9; p < 0.001) or platinum-based chemotherapy (HR = 2.7; CI 1.5-4.9; p < 0.001), whereas a previous diagnosis of brain tumour (HR = 10; CI 1.2-45; p < 0.05) and anthracyclines exposure (HR = 1.3; CI 1.2-26; p < 0.05) significantly predicted obesity.
  
  
  CONCLUSIONS
  CCSs show a high and variable risk for developing dyslipidaemia and obesity, depending on cancer diagnosis and treatments. Therefore, they need accurate and tailored control of their cardiovascular risk profile.
authors.affiliation: Transition Unit for Childhood Cancer Survivors, Città della Salute e della Scienza Hospital, Turin, Italy Division of Oncological Endocrinology, University of Torino, Turin, Italy fabrizio.dascenzo@gmail.com.
authors.forename: Francesco
authors.initials: F
authors.lastname: Felicetti
authors.affiliation: Division of Cardiology, Città della Salute e della Scienza Hospital, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: D'Ascenzo
authors.affiliation: Division of Cardiology, Città della Salute e della Scienza Hospital, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Moretti
authors.affiliation: Division of Paediatric Endocrinology, Città della Salute e della Scienza Hospital, Turin, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Corrias
authors.affiliation: Division of Cardiology, Città della Salute e della Scienza Hospital, Italy.
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Omedè
authors.affiliation: Division of Cardiology, Città della Salute e della Scienza Hospital, Italy.
authors.forename: Walter Grosso
authors.initials: WG
authors.lastname: Marra
authors.affiliation: Division of Oncological Endocrinology, University of Torino, Turin, Italy.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Arvat
authors.affiliation: Division of Paediatric Haematology/Oncology, Città della Salute e della Scienza Hospital, Turin, Italy.
authors.forename: Franca
authors.initials: F
authors.lastname: Fagioli
authors.affiliation: Transition Unit for Childhood Cancer Survivors, Città della Salute e della Scienza Hospital, Turin, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Brignardello
authors.affiliation: Division of Cardiology, Città della Salute e della Scienza Hospital, Italy.
authors.forename: Fiorenzo
authors.initials: F
authors.lastname: Gaita
mesh_terms: D000328:Adult; D000367:Age Factors; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology*; D016009:Chi-Square Distribution; D008078:Cholesterol, LDL / Q000097:blood; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D006937:Hypercholesterolemia / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D015228:Hypertriglyceridemia / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D015999:Multivariate Analysis; D009369:Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D009765:Obesity / Q000175:diagnosis / Q000453:epidemiology*; D015995:Prevalence; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D017741:Survivors; D013997:Time Factors; D014280:Triglycerides / Q000097:blood; D014916:Whole-Body Irradiation / Q000009:adverse effects; D055815:Young Adult
chemical_list: D015415:Biomarkers; D008078:Cholesterol, LDL; D014280:Triglycerides
keywords: Childhood cancer survivors; cardiovascular risk; dyslipidaemia; late-effects; long-term follow-up; obesity