Are Hodgkin Lymphoma Survivors at Greater Risk For CVD?

Hodgkin lymphoma survivors have an increased risk of cardiovascular disease for at least 40 years after diagnosis of the cancer, according to a study published April 27 in JAMA Internal Medicine.

In a retrospective cohort study, researchers analyzed data from 2,524 Dutch Hodgkin lymphoma patients, diagnosed prior to 51 years of age, for incidence of cardiovascular events, including myocardial infarction, angina pectoris, valvular heart disease and heart failure. Patient treatments included mediastinal radiotherapy and anthracycline doses.

Compared with the general population, the study showed that Hodgkin lymphoma patients had four-fold to seven-fold increased risks of coronary heart disease or heart failure 35 years or more after treatment. There were 1,713 cardiovascular events in 797 patients, with 410 patients having two or more events. Coronary heart disease was the most commonly occurring cardiovascular disease (401 events), followed by valvular heart disease (374) and heart failure (140). Further, for Hodgkin lymphoma patients who received treatment before age 25, the cumulative risk at age 60 or older was 20 percent for coronary heart disease, 31 percent for valvular heart disease and 11 percent for heart failure.

The authors note that the “screening guidelines for childhood cancer survivors treated with mediastinal radiotherapy and anthracyclines... should be extended to survivors of adult Hodgkin lymphoma” in order to ensure appropriate care for these patients.

“Ultimately, we will need large, long-term prospective studies and randomized clinical trials to guide evidence-based practice in regard to defining the best approaches,” said Emily Tonorezos, MD, MPH, and Linda Overholser, MD, MPH, in an accompanying editorial comment. “How we incorporate additional risk factors attributable to past exposures into consideration of treatment recommendations for our patients and use of... guidelines needs to be tailored to each clinical scenario.”

“This study continues to raise awareness about the high risk population of cancer survivors who, years after successful therapy present with increased risk of coronary heart disease, valvular disease and heart failure,” said Ana Barac, MD, PhD, FACC, chair of the ACC’s Cardio-Oncology Work Group. “Their risk is not readily captured in our coronary heart disease/atherosclerotic cardiovascular disease or heart failure risk prediction models and there are limited clinical practice standards to guide  prevention and personalized treatment in these patients. From a cardiologist's perspective, this manuscript is important as it continues to build a platform of knowledge about the specific cardiovascular needs in a select group of cancer survivors and sets the stage for future prospective studies and randomized clinical trials to improve outcomes.”

Clinical Topics: Cardio-Oncology, Heart Failure and Cardiomyopathies, Valvular Heart Disease, Atherosclerotic Disease (CAD/PAD), Acute Heart Failure

Keywords: Angina Pectoris, Anthracyclines, Cohort Studies, Coronary Artery Disease, Coronary Disease, Heart Failure, Heart Valve Diseases, Hodgkin Disease, Incidence, Myocardial Infarction, Prospective Studies, Risk Factors, Survivors, Cardiotoxicity

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