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Lifestyle factors and subsequent ischemic heart disease risk after hematopoietic cell transplantation
Author(s) -
Leger Kasey J.,
Baker K. Scott,
CushingHaugen Kara L.,
Flowers Mary E. D.,
Leisenring Wendy M.,
Martin Paul J.,
Mendoza Jason A.,
Reding Kerryn W.,
Syrjala Karen L.,
Lee Stephanie J.,
Chow Eric J.
Publication year - 2018
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.31227
Subject(s) - medicine , hazard ratio , transplantation , heart transplantation , risk factor , dyslipidemia , disease , diabetes mellitus , myocardial infarction , cohort , confidence interval , endocrinology
BACKGROUND The objective of this study was to evaluate whether modifiable cardiovascular risk conditions and lifestyle factors were temporally associated with an increased risk for ischemic heart disease and overall mortality in a cohort of hematopoietic cell transplantation (HCT) survivors. METHODS HCT recipients who had survived for ≥1 year, were ≥20 years old, and had undergone transplantation between 1970 and 2010 at a transplant referral center were surveyed in 2010‐2011 about cardiovascular health and lifestyle factors (n = 3833). Respondents (n = 2360 [61.6%]) were followed to 2016 for incident ischemic heart disease and overall mortality. RESULTS Among the 2360 transplant survivors (median age at the baseline survey, 55.9 years; median time since transplantation, 10.8 years), 162 (6.9%) reported ischemic heart disease at the baseline survey. Among those without ischemic heart disease at the baseline survey (n = 2198), the 5‐year cumulative incidence of subsequent ischemic heart disease was 4.3%. Obesity, dyslipidemia, diabetes, and physical inactivity at baseline were associated with an increased risk for subsequent ischemic heart disease (hazard ratio [HRs] ≥ 1.8). Greater physical activity and fruit/vegetable intake at baseline were associated with subsequent lower overall mortality (HRs ≤ 0.7). When jointly considered, each additional cardiovascular risk condition and each adverse lifestyle factor were independently associated with subsequent ischemic heart disease (HR for risk conditions, 1.4; 95% confidence interval [CI], 1.0‐1.9; HR for lifestyle factors, 1.9; 95% CI, 1.2‐2.9), and adverse lifestyle factors remained associated with overall mortality (HR, 1.8; 95% CI, 1.5‐2.3). CONCLUSIONS These results support strong efforts to promote healthy lifestyle behaviors and to treat cardiovascular risk factors aggressively in HCT survivors. This may reduce future ischemic heart disease and overall mortality in this high‐risk population. Cancer 2018;124:1507‐15 . © 2018 American Cancer Society .