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

Saro H. Armenian, Can-Lan Sun, Tabitha Vase, Kirsten K. Ness, Emily Blum, Liton Francisco, Kalyanasundaram Venkataraman, Raynald Samoa, F. Lennie Wong, Stephen J. Forman and Smita Bhatia


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.