Blood Journal
Leading the way in experimental and clinical research in hematology

Cardiovascular risk factors in hematopoietic cell transplantation (HCT) survivors: role in development of subsequent cardiovascular disease

  1. Saro H. Armenian1,*,
  2. Can-Lan Sun1,
  3. Tabitha Vase1,
  4. Kirsten K. Ness2,
  5. Emily Blum1,
  6. Liton Francisco1,
  7. Kalyanasundaram Venkataraman3,
  8. Raynald Samoa4,
  9. F. Lennie Wong1,
  10. Stephen J. Forman5, and
  11. Smita Bhatia1
  1. 1 Department of Population Sciences, City of Hope, Duarte, CA, United States;
  2. 2 Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, United States;
  3. 3 Department of Cardiology, City of Hope, Duarte, CA, United States;
  4. 4 Department of Diabetes, Endocrinology and Metabolism, City of Hope, Duarte, CA, United States;
  5. 5 Department of Hematology & Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
  1. * Corresponding author; email: sarmenian{at}coh.org

Abstract

HCT recipients may be at an increased risk of developing hypertension, diabetes and dyslipidemia (referred to as cardiovascular risk factors ([CVRFs]); and these can potentially increase the risk of cardiovascular disease (CVD). We examined the incidence and predictors of CVRFs and subsequent CVD in 1885 consecutive 1+year survivors of HCT performed at City of Hope between 1995 and 2004. Ten-year cumulative incidence (CI) of hypertension, diabetes, dyslipidemia, and multiple (≥2) CVRFs was 37.7%, 18.1%, 46.7%, and 31.4%, respectively. The prevalence of CVRFs was significantly higher among HCT recipients compared to the general population; contributed to largely by allogeneic HCT recipients. Older age and obesity at HCT were associated with increased risk of CVRFs. History of Grade II-IV acute graft versus host disease was associated with an increased risk for hypertension (RR=9.1, p<0.01), diabetes (RR=5.8, p<0.01) and dyslipidemia (RR=3.2, p<0.01); conditioning with total body irradiation was associated with an increased risk of diabetes (RR=1.5, p=0.01) and dyslipidemia (RR=1.4, p<0.01). There was an incremental increase in 10-year incidence of CVD by number of CVRFs (4.7% [none], 7.0% [1 CVRF], 11.2% [≥2 CVRFs], p<0.01); the risk was especially high (15.0%) in patients with multiple CVRFs and pre-HCT exposure to anthracyclines or chest radiation.

  • Submitted June 13, 2012.
  • Accepted August 14, 2012.