Heart disease risk persists in Hodgkin’s survivors
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Survivors of Hodgkin’s disease are at high risk for cardiovascular disease, a Swedish study confirms. The risk is particularly high for patients treated for Hodgkin’s disease before the age of 40 years and with a family history of heart disease.
In the International Journal of Cancer, the investigators note that “previous studies have shown increased cardiovascular mortality as late side effects (in) Hodgkin’s lymphoma patients.” The aim of the current study, Dr. Anne Andersson of Umea University and colleagues explain, was to stratify heart disease risk factors for surveillance.
Hodgkin’s disease, also known as Hodgkin’s lymphoma, is a cancer of the lymphatic system, a part of the immune system. Compared with some other types of lymphoma, Hodgkin’s lymphoma usually responds to treatment and most patients can be cured. Because it frequently affects children and young adults, there is a prolonged period in which long-term side effects can develop.
The investigators used the Swedish Cancer Registry to identify 6946 patients diagnosed with Hodgkin’s lymphoma between 1965 and 1995 and the Swedish Multigenerational Registry to identify a total of 17,858 first-degree relatives of the patients.
Among 4,635 Hodgkin’s lymphoma patients who survived 1 year or longer after diagnosis, 1,413 episodes of inpatient care for coronary artery disease, congestive heart failure, stroke and/or valvular disease in 698 individuals were recorded in the Swedish Hospital Discharge Registry.
The average follow-up period was 11.8 years and, according to the investigators, the risk of cardiovascular disease was “increasing at the time of follow-up and the risk was higher for those treated for Hodgkin’s lymphoma before the age of 40.”
The risk of cardiovascular disease 10 to 19 years after Hodgkin’s lymphoma treatment was increased by 3-fold for all Hodgkin’s lymphoma patients, and by 5.5-fold in patients with a positive family history of cardiovascular disease.
For Hodgkin’s lymphoma survivors treated before age 40, the risk of developing congestive heart failure 10 to 19 years after treatment was increased by 3.5-fold, and by 6.7-fold for those with a positive family history of cardiovascular disease, the report states.
For Hodgkin’s lymphoma survivors treated before the age 40 and followed for 20 years or longer, there was a 10-fold increase in risk for congestive heart failure. For this group, a positive family history of congestive heart failure increased this risk by 25-fold.
Andersson and colleagues conclude, “A family history of cardiovascular disease could be particularly important for identifying patients at risk for early coronary artery disease and congestive heart failure.”
These findings, they add, support those of two other large studies, which also highlight the “need for cardiovascular intervention in this high risk group.”
SOURCE: International Journal of Cancer, April 15, 2009.
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