Trends and Disparities in Cardiovascular Mortality Among Survivors of Hodgkin Lymphoma.
BACKGROUND
Over the past decades, survival of patients with Hodgkin lymphoma (HL) has increased but remains curtailed by cardiovascular mortality (CVM). HL survivors at greatest risk for cardiovascular death have not been clearly identified. We sought to report trends of CVM identify HL survivors at highest risk.


METHODS
The Surveillance, Epidemiology, and End Results (SEER) database was queried for all adult patients diagnosed with HL (age 20-49 years) between 1990 and 2011. The trend of CVM and disparities are presented.


RESULTS
Of 19,781 HL patients, 53% were male and 83% were white; patients had a mean age of 33 ± 8.3 years at diagnosis. Eighteen percent had stage I disease, 45% stage II, 18% stage III, and 15% stage IV. The risk for CVM was higher in blacks (adjusted hazard ratio [HR], 1.97; P = .002), men (adjusted HR, 2.2; P < .001), and patients with older age at diagnosis (adjusted HR, 1.073 per year; P < .001). CVM has decreased, with 5-year cumulative incidence decreasing from 1.17% in 1990 to 0.18% in 2006, averaging 7% per year (adjusted HR, 0.927; P < .001). This trend was seen only in patients with early disease (P < .001) but not with advanced disease (P = NS). CVM as a proportion of all-cause mortality increases sharply at 50 years of age, constituting more than 30% of all causes of death.


CONCLUSIONS
Despite an overall decrease in CVM in HL survivors over the last decades, older patients, black patients, and men, especially those who have advanced-stage disease at diagnosis, are at the highest risk of cardiovascular death. Cardiovascular screening and risk modification should be intensified in HL patients with these characteristics.
Onco-cardiology program, Harrington Heart and Vascular Institute, and Seidman Cancer Center, University Hospitals, Cleveland, OH; School of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH.
Sadeer G
SG
Al-Kindi
New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY.
Ghaith F
GF
Abu-Zeinah
Onco-cardiology program, Harrington Heart and Vascular Institute, and Seidman Cancer Center, University Hospitals, Cleveland, OH; School of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH.
Chang H
CH
Kim
Onco-cardiology program, Harrington Heart and Vascular Institute, and Seidman Cancer Center, University Hospitals, Cleveland, OH.
Vittal
V
Hejjaji
School of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH; University Hospitals Seidman Cancer Center, Cleveland, OH.
Basem M
BM
William
School of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH; University Hospitals Seidman Cancer Center, Cleveland, OH.
Paolo F
PF
Caimi
Onco-cardiology program, Harrington Heart and Vascular Institute, and Seidman Cancer Center, University Hospitals, Cleveland, OH; School of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH; University Hospitals Seidman Cancer Center, Cleveland, OH. Electronic address: guilherme.oliveira@uhhospitals.org.
Guilherme H
GH
Oliveira
D000328:Adult; D001741:Black or African American; D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D054624:Health Status Disparities; D006689:Hodgkin Disease / Q000401:mortality*; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D017678:Sex Distribution; D017741:Survivors; D044465:White People; D055815:Young Adult
Cardiovascular disease; Hodgkin lymphoma; Mortality; Race; SEER