Cardiovascular risk factors in hematopoietic cell transplantation survivors: role in development of subsequent cardiovascular disease
Cardiovascular risk factors in hematopoietic cell transplantation survivors: role in development of subsequent cardiovascular disease
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DOI：
10.1182/blood-2012-06-437178
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发表时间：
2012-11-29
期刊：
影响因子：
20.3
通讯作者：
Bhatia, Smita
中科院分区：
文献类型：
--
作者：
Armenian, Saro H.;Sun, Can-Lan;Bhatia, Smita
造血细胞移植(HCT)受者患高血压、糖尿病和血脂异常(称为心血管危险因素[CVRF])的风险可能增加；这些因素可能会增加心血管疾病(CVD)的风险。我们研究了1995-2004年间在希望之城连续1年以上的1885例HCT患者的CVRFs和随后的CVD的发生率和预测因素。高血压、糖尿病、血脂异常和多发性(>；=2)CVRF的十年累积发病率分别为37.7%、18.1%、46.7%和31.4%。与普通人群相比，HCT受者的CVRFs患病率明显更高；这主要是由异基因HCT受者造成的。在HCT中年龄较大和肥胖与CVRF风险增加相关。II-IV级急性移植物抗宿主病病史与高血压(相对风险[RR]=9.1，P<0.01)、糖尿病(RR=5.8，P<0.01)和血脂异常(RR=3.2，P<0.01)的风险增加相关；接受全身照射的调理与糖尿病(RR=1.5，P=0.01)和血脂异常(RR=1.4，P<；01)的风险增加相关。随着CVRF数目的增加，CVD的10年发病率增加(4.7%[无]，7.0%[1个CVRF]，11.2%[=2个CVRF]，P<；.01)；在多个CVRF和HCT前暴露于蒽环类药物或胸部放射的患者中，风险尤其高(15.0%)。(血。2012；120(23)：4505-4512)
Hematopoietic cell transplantation (HCT) recipients may be at an increased risk of developing hypertension, diabetes, and dyslipidemia (referred to as cardiovascular risk factors [CVRFs]); and these factors 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 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 with 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 (relative risk [RR] = 9.1, P < .01), diabetes (RR = 5.8, P < .01), and dyslipidemia (RR = 3.2, P < .01); conditioning with total body irradiation was associated with an increased risk of diabetes (RR = 1.5, P = .01) and dyslipidemia (RR = 1.4, P < .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 < .01); the risk was especially high (15.0%) in patients with multiple CVRFs and pre-HCT exposure to anthracyclines or chest radiation. (Blood. 2012;120(23):4505-4512)