Childhood cancer survivors have increased risk of dyslipidemia and atherosclerotic cardiovascular disease (ASCVD). The aim of this study was to evaluate the prevalence and associated cardiovascular risks of specific lipid abnormalities among childhood cancer survivors.
Comprehensive lipid panel measurements were obtained from 4,115 5-year survivors, with 3,406 (mean age at evaluation 35.2 ± 10.4 years) not having previous dyslipidemia diagnosis, as well as 624 age, sex, and race/ethnicity matched community controls.
Previously undiagnosed dyslipidemia with abnormal LDL-C (>160 mg/dL), non-HDL-C (>190 mg/dL), HDL-C (<40 mg/dL for men, 150 mg/dL) were identified in 4%, 6%, 30%, and 17%, respectively. Survivors without previous dyslipidemia diagnosis had higher LDL-C and non-HDL-C and lower HDL-C than community controls. Cranial radiotherapy (RR 2.2, 95%CI 1.6-3.0 for non-HDL-C) and total body irradiation for hematopoietic cell transplantation (RR 6.7, 95%CI 3.5-13.0 for non-HDL-C; RR 9.9, 95%CI 6.0-16.3 for triglycerides) were associated with greater risk of dyslipidemia. Diagnoses of low HDL-C (HR 2.9, 95%CI 1.8-4.7) and elevated triglycerides (HR 3.1, 95%CI 1.9-5.1) were associated with increased risk for myocardial infarction, and diagnoses of high LDL-C (HR 2.2, 95%CI 1.3-3.7), high non-HDL-C (HR 2.2, 95%CI 1.3-3.7), low HDL-C (HR 3.9, 95%CI 2.8-5.4), and elevated triglycerides (HR 3.8, 95%CI 2.7-5.5) were associated with increased risk for cardiomyopathy.
Previously undiagnosed dyslipidemia among childhood cancer survivors was associated with increased risk for myocardial infarction and cardiomyopathy. Comprehensive dyslipidemia evaluation and treatment are needed to reduce cardiovascular morbidity in this population.
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