Cardiac risk persists long after Hodgkin’s therapy
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The improved prognosis of patients diagnosed with Hodgkin’s disease is tempered by the increased risk of cardiovascular disease, a side effect of treatment that can persist for decades.
The risk of a variety of cardiovascular disorders remains up to 5-fold higher for more than 25 years in survivors of this childhood lymphoma, compared with the general population, investigators report in the medical journal “Blood.”
The risk of fatal heart disease after treatment for Hodgkin’s lymphoma is well documented, Dr. Flora E. van Leeuwen, from The Netherlands Cancer Institute in Amsterdam, and her associates note, but examination of the risk of other cardiovascular disorders has been neglected, they add.
They therefore assessed the long-term cardiovascular disease risk in a group of 1474 patients, who survived Hodgkin’s lymphoma for at least 5 years, and were treated between 1965 and 1995. The average follow-up time was 20.1 years for the 1017 patients still alive at the end of the study.
Records showed that 28 percent received radiotherapy only; 5 percent had chemotherapy only; 38 percent were treated with radiotherapy and chemotherapy, which did not include anthracyclines, drugs known to damage the heart; and 29 percent received radiotherapy plus chemotherapy with anthracyclines. Of these patients, a total of 84 percent were treated with radiotherapy to the chest.
The average age at start of treatment was 25.7 years, although 314 patients were 20 or younger.
Van Leeuwen’s group detected 160 cases of valve disorders, 134 cases of angina, 102 heart attacks and 52 cases of congestive heart failure. They estimated that the patients had a 3.6-fold increased risk of heart attack and a 4.9-fold increased risk of congestive heart failure.
The average time between the start of Hodgkin’s treatment and diagnosis of cardiovascular disease was about 19 years. However, the risk of heart attack was significantly elevated beginning 9 years earlier. The risk of all cardiovascular diseases combined were increased for a minimum of 25 years, the investigators report.
Among subjects treated before age 20, the risk of angina and congestive heart failure were significantly higher than for those treated when they were older, suggesting that “immature cardiovascular tissue may be more vulnerable to radiation and chemotherapy.”
Van Leeuwen’s team hopes the outlook for survivors of Hodgkin’s lymphoma will brighten over time, as fewer patients are receiving radiation therapy, and when they do, dosages are reduced and patients’ hearts are at least partially shielded.
For now, “especially in young survivors of Hodgkin’s lymphoma” with treatment-related cardiovascular risk, they recommend that doctors consider risk-reducing strategies, such as treating high blood pressure and high cholesterol, and advising patients to eliminate controllable risk factors, such smoking.
SOURCE: Blood, March 1, 2007.
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