Challenges Predicting the Cardiovascular Future for Survivors of Childhood Cancer

Cardiovascular disease (CVD) risk stratification relies on assessment of nonmodifiable (age, sex, family history) and modifiable (weight, tobacco, physical activity, blood pressure, glucose/lipid levels) risk factors. Cancer therapy, itself a potential risk factor, may alter metabolism in long-term survivors of childhood cancer resulting in premature acquisition of age-related modifiable CVD risk factors. For survivors exposed to cardiotoxic therapies, the risk for CVD is significantly augmented by obesity, diabetes, dyslipidemia, and hypertension. An understanding of these risks may not be well communicated as survivors return to primary care and general population screening practices may be insufficient. Lipshultz and colleagues recruited childhood cancer survivors to return to their treating institution for a comprehensive clinical assessment. Interestingly, compared with a noncancer age-, sex-, and race/ethnicity-matched National Health and Nutrition Examination Survey population, cardiometabolic profiles were largely similar. However, cancer survivors had a higher prevalence of prehypertension/hypertension (38.4% vs. 30.1%, P = 0.04) and a lower prevalence of the metabolic syndrome (11.9% vs. 18.7%, P = 0.05). Applying general population CVD risk calculators and a cancer-specific model from the Childhood Cancer Survivor Study, risk estimates were notably higher when cardiotoxic cancer treatment exposures were included.