title: Prevalence of cardiovascular late sequelae in long-term survivors of childhood cancer: A systematic review and meta-analysis.
abstract: BACKGROUND
  Cardiovascular diseases are well-known late effects of childhood cancer and research on these late effects is a highly important emerging field. We conducted a systematic review with a meta-analysis to give an overview of the current evidence and the prevalence of late cardiovascular events.
  
  
  METHODS
  We included publications in which the study populations were children and adolescents who survived cancer. Outcome was defined as all cardiovascular clinical and subclinical endpoints or diagnoses appearing at least one year after cancer diagnosis. A systematic overview is presented for all included studies. A quantitative meta-analysis was conducted for hypertension and stroke.
  
  
  RESULTS
  Sixty-four papers were included in the review. The age range at cancer diagnosis was 0-24 years; age at the end of follow-up ranged from 7 to 71 years. Prevalence of cardiovascular late effects varied from 0% for stroke up to 70% for subclinical hypertension. Large heterogeneity was found regarding study size, study design, definition of endpoints, and investigation/examination method. The weighted average prevalence was 19.7% for hypertension and 2.3% for stroke. As no specific results for gender, cancer therapy, or age at cancer diagnosis were present in most papers, a detailed comparison and pooled analysis was difficult.
  
  
  CONCLUSIONS
  This review showed the vast range of cardiovascular late effects after childhood or adolescent cancer therapy. The differences between the papers prevented drawing a conclusive picture of the prevalence of cardiovascular late effects. Large cohort studies and better reporting are needed to improve the knowledge on this topic.
authors.affiliation: Institute for Medical Biostatistics, Epidemiology and Informatics, University Medicine of the Johannes Gutenberg-University Mainz, Mainz, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Scholz-Kreisel
authors.affiliation: German Childhood Cancer Registry at the Institute for Medical Biostatistics, Epidemiology and Informatics, University Medicine of the Johannes Gutenberg-University Mainz, Mainz, Germany.
authors.forename: Claudia
authors.initials: C
authors.lastname: Spix
authors.affiliation: Institute for Medical Biostatistics, Epidemiology and Informatics, University Medicine of the Johannes Gutenberg-University Mainz, Mainz, Germany.
authors.forename: Maria
authors.initials: M
authors.lastname: Blettner
authors.affiliation: Department of Pediatric Hematology/Oncology, University Medicine of the Johannes Gutenberg-University Mainz, Mainz, Germany.
authors.forename: Susan
authors.initials: S
authors.lastname: Eckerle
authors.affiliation: Department of Pediatric Hematology/Oncology, University Medicine of the Johannes Gutenberg-University Mainz, Mainz, Germany.
authors.forename: Jörg
authors.initials: J
authors.lastname: Faber
authors.affiliation: Preventive Cardiology and Preventive Medicine, Center for Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.|Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.|German Center for Cardiovascular Research (DZHK), Partner Site RhineMain, Mainz, Germany.|Center for Translational Vascular Biology (CTVB), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Wild
authors.affiliation: Institute for Medical Biostatistics, Epidemiology and Informatics, University Medicine of the Johannes Gutenberg-University Mainz, Mainz, Germany.
authors.forename: Hiltrud
authors.initials: H
authors.lastname: Merzenich
authors.affiliation: Department of Paediatric Haematology and Oncology, Center for Paediatrics, University Hospital Gießen and Marburg, Giessen, Germany.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Hennewig
mesh_terms: D000293:Adolescent; D000328:Adult; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology* / Q000209:etiology; D007223:Infant; D008297:Male; D009369:Neoplasms / Q000150:complications*; D015995:Prevalence; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology; D017741:Survivors; D055815:Young Adult
keywords: cardiac sequelae; childhood cancer; late effects; vascular sequelae