title: Endothelial dysfunction and cardiovascular risk factors in childhood acute lymphoblastic leukemia survivors.
abstract: BACKGROUND
  Childhood acute lymphoblastic leukemia (ALL) survivors have increased risk of obesity, metabolic alterations and cardiovascular disease (CVD). Vascular endothelial function has been studied in adult cancers. Limited data exist regarding CVD risk factors among childhood ALL survivors. We aimed to assess endothelial function, metabolic and cardiovascular risk factors in young survivors of childhood ALL.
  
  
  METHODS
  Auxological parameters, blood pressure, glucose, lipid profile, hemostatic markers (total adiponectin and high-molecular-weight subfraction, endothelin-1, von Willebrand factor antigen, thrombin-antithrombin complex, D-dimers, fibrinogen), high sensitive C-reactive protein and ultrasound parameters of endothelial function (flow-mediated dilation-FMD, common carotid intima-media thickness-C-IMT, and antero-posterior diameter of infra-renal abdominal aorta-APAO) were assessed in 52 ALL survivors and 34 sex and age-matched controls.
  
  
  RESULTS
  ALL patients and controls were not statistically different as regards body mass index and waist circumference. Blood pressure, glucose, total and LDL-cholesterol, triglycerides, high sensitive C-reactive protein were statistically higher in ALL than in controls, while HDL-cholesterol was lower in ALL than in controls. Patients showed statistically lower high-molecular-weight adiponectin and thrombin-antithrombin complex (p=0.003 and p<0.001, respectively) and higher vonWillebrand factor antigen (p=0.002) than controls. FMD was lower in patients than in controls (p<0.001). Biomarkers of endothelial function, systolic blood pressure and waist circumference were correlated to FMD.
  
  
  CONCLUSIONS
  ALL survivors showed derangement of endothelial function, which likely occurs during chemotherapy and lasts till follow up. They showed metabolic alterations even though obesity was not documented. Endothelial vascular parameters should be evaluated earlier during follow-up to detect preclinical onset of CVD.
authors.affiliation: Department of Biomedicine and Human Oncology, Pediatric Section, University "A. Moro" of Bari, Piazza G. Cesare 11, 70124 Bari, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Giordano
authors.affiliation: Department of Biomedicine and Human Oncology, Pediatric Section, University "A. Moro" of Bari, Piazza G. Cesare 11, 70124 Bari, Italy. Electronic address: paola.muggeo@tiscali.it.
authors.forename: Paola
authors.initials: P
authors.lastname: Muggeo
authors.affiliation: Department of Biomedicine and Human Oncology, Pediatric Section, University "A. Moro" of Bari, Piazza G. Cesare 11, 70124 Bari, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Delvecchio
authors.affiliation: Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University "A. Moro" of Bari, Piazza G. Cesare 11, 70124 Bari, Italy.
authors.forename: Santa
authors.initials: S
authors.lastname: Carbonara
authors.affiliation: Department of Biomedicine and Human Oncology, Pediatric Section, University "A. Moro" of Bari, Piazza G. Cesare 11, 70124 Bari, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Romano
authors.affiliation: Department of Biomedicine and Human Oncology, Pediatric Section, University "A. Moro" of Bari, Piazza G. Cesare 11, 70124 Bari, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Altomare
authors.affiliation: Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University "A. Moro" of Bari, Piazza G. Cesare 11, 70124 Bari, Italy.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Ricci
authors.affiliation: Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University "A. Moro" of Bari, Piazza G. Cesare 11, 70124 Bari, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Valente
authors.affiliation: Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University "A. Moro" of Bari, Piazza G. Cesare 11, 70124 Bari, Italy.
authors.forename: Annapaola
authors.initials: A
authors.lastname: Zito
authors.affiliation: Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University "A. Moro" of Bari, Piazza G. Cesare 11, 70124 Bari, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Scicchitano
authors.affiliation: Department of Biomedicine and Human Oncology, Pediatric Section, University "A. Moro" of Bari, Piazza G. Cesare 11, 70124 Bari, Italy.
authors.forename: Luciano
authors.initials: L
authors.lastname: Cavallo
authors.affiliation: Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University "A. Moro" of Bari, Piazza G. Cesare 11, 70124 Bari, Italy.
authors.forename: Marco Matteo
authors.initials: MM
authors.lastname: Ciccone
authors.affiliation: Department of Biomedicine and Human Oncology, Pediatric Section, University "A. Moro" of Bari, Piazza G. Cesare 11, 70124 Bari, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Santoro
authors.affiliation: Department of Biomedicine and Human Oncology, Pediatric Section, University "A. Moro" of Bari, Piazza G. Cesare 11, 70124 Bari, Italy.
authors.forename: Maria Felicia
authors.initials: MF
authors.lastname: Faienza
mesh_terms: D000293:Adolescent; D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications* / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D018616:Ultrasonography, Doppler, Duplex; D014664:Vasodilation / Q000502:physiology*; D055815:Young Adult
keywords: Acute lymphoblastic leukemia; Adiponectin; Cardiovascular disease; FMD; Metabolism; Vascular ultrasound studies