Traditional cardiovascular risk factors and individual prediction of cardiovascular events in childhood cancer survivors
Menée auprès de 27 699 participants et à l'aide de 12 modèles prédictifs, cette étude analyse l'importance des facteurs de risque cardiovasculaire traditionnels pour prédire le risque de maladie cardiovasculaire chez les adultes ayant survécu à un cancer diagnostiqué durant l'enfance
Background : Childhood cancer survivors have an increased risk of heart failure, ischemic heart disease, and stroke. They may benefit from prediction models that account for cardiotoxic cancer treatment exposures combined with information on traditional cardiovascular risk factors such as hypertension, dyslipidemia, and diabetes.
Methods : Childhood Cancer Survivor Study participants (n = 22,643) were followed through age 50y for incident heart failure, ischemic heart disease, and stroke. Siblings (n = 5,056) served as a comparator. Participants were assessed longitudinally for hypertension, dyslipidemia, and diabetes based on self-reported prescription medication use. Half the cohort was used for discovery; the remainder for replication. Models for each outcome were created for survivors ages 20y, 25y, 30y, and 35y at the time of prediction (n = 12 models).
Results : For discovery, risk scores based on demographic, cancer treatment, hypertension, dyslipidemia, and diabetes information achieved areas under the receiver operating characteristic curve (AUC) and concordance (C) statistics ≥0.70 in 9 and 10 of the 12 models, respectively. For replication, AUCs and C-statistics ≥0.70 were observed in 7 and 9 of the models, respectively. Across outcomes, the most influential exposures were anthracycline, radiotherapy, diabetes, and hypertension. Survivors were then assigned to statistically distinct moderate- and high-risk groups corresponding to age 50y cumulative incidences of each target outcome <3% and approximately ≥10%, respectively. Siblings had cumulative incidences ≤1% for all outcomes.
Conclusions : Traditional cardiovascular risk factors remain important for predicting risk of cardiovascular disease among adult-aged survivors of childhood cancer. These prediction models provide a framework to base future surveillance strategies and interventions.
Journal of the National Cancer Institute , résumé, 2018