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Metabolic syndrome and cardiovascular risk among long‐term survivors of acute lymphoblastic leukaemia ‐ From the St. Jude Lifetime Cohort
Author(s) -
Nottage Kerri A.,
Ness Kirsten K.,
Li Chenghong,
Srivastava Deokumar,
Robison Leslie L.,
Hudson Melissa M.
Publication year - 2014
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/bjh.12754
Subject(s) - medicine , relative risk , metabolic syndrome , national health and nutrition examination survey , cohort , obesity , cohort study , confidence interval , body mass index , risk factor , national cholesterol education program , pediatrics , population , environmental health
Summary Adult survivors of childhood acute lymphoblastic leukaemia ( ALL ) have a four‐fold excess risk of mortality from cardiovascular disease. This cardiovascular risk has not been fully characterized. ALL survivors [ n = 784, median age 31·7 years (18·9–59·1)] in the St. Jude Lifetime Cohort Study underwent evaluation for cardiovascular risk and metabolic syndrome (MetS) according to National Cholesterol Education Program – Adult Treatment Panel III criteria. Comparisons were made to 777 age‐, sex‐, and race‐matched controls from the National Health and Nutrition Examination Survey ( NHANES ). MetS was identified in 259 survivors (33·6%) and associated with older age in 5‐year increments (relative risk [ RR ] 1·13, 95% confidence interval [ CI ] 1·06–1·19) and prior cranial radiotherapy ( CRT ) (with craniospinal radiation: RR 1·88, 95% CI 1·32–2·67; without: RR 1·67, 95% CI 1·26–2·23). Measures of obesity were highly prevalent among female survivors and CRT recipients. Compared to NHANES controls, ALL survivors had a higher risk of MetS ( RR 1·43, 95% CI 1·22–1·69), hypertension ( RR 2·43, 95% CI 2·06–2·86), low high‐density lipoprotein ( RR 1·40, 95% CI 1·23–1·59), obesity ( RR 1·47, 95% CI 1·29–1·68) and insulin resistance (1·64, 95% CI 1·44–1·86). This large study of clinically evaluated ALL survivors identified a high prevalence of MetS, obesity and cardiovascular risk, particularly in CRT recipients, underscoring the need for screening and aggressive reduction of modifiable risks.