Traditional Cardiovascular Risk Factors and Individual Prediction of Cardiovascular Events in Childhood Cancer Survivors
Traditional Cardiovascular Risk Factors and Individual Prediction of Cardiovascular Events in Childhood Cancer Survivors
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DOI：
10.1093/jnci/djz108
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发表时间：
2020-03-01
影响因子：
10.3
通讯作者：
Yasui, Yutaka
中科院分区：
文献类型：
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作者：
Chen, Yan;Chow, Eric J.;Yasui, Yutaka
背景：儿童癌症幸存者有心力衰竭、缺血性心脏病和中风的风险增加。他们可能会受益于预测模型，占心脏毒性癌症治疗暴露与传统的心血管危险因素，如高血压，血脂异常，和diabetes.Methods的信息相结合：儿童癌症幸存者研究参与者（n=22 643）进行了随访，通过年龄50 years的事件心力衰竭，缺血性心脏病，中风。西司他滨（n=5056）作为对照药物。根据自我报告的处方药使用情况，对参与者的高血压、血脂异常和糖尿病进行纵向评估。一半的队列用于发现;其余的用于复制。为预测时年龄为20岁、25岁、30岁和35岁的幸存者创建了每个结局的模型（n=12个模型）。结果：对于发现，基于人口统计学、癌症治疗、高血压、血脂异常和糖尿病信息的风险评分在12个模型中的9个和10个中达到了受试者工作特征曲线下面积和一致性统计量0.70或更大，分别对于重复，分别在7个和9个模型中观察到受试者工作特征曲线下面积和一致性统计量≥ 0.70。在结果中，最有影响力的暴露是蒽环类药物化疗、放疗、糖尿病和高血压。然后将幸存者分配到统计学上不同的风险组，对应于50岁时每个目标结局的累积发生率小于3%（中度风险）或约10%或更高（高风险）。所有结果的累积发病率为1%或更少之间siblings.Conclusions：传统的心血管危险因素仍然是重要的预测心血管疾病的风险在成年年龄的儿童癌症幸存者。这些预测模型为今后的监测战略和干预措施提供了一个框架。
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 50years for incident heart failure, ischemic heart disease, and stroke. Siblings (n=5056) 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 20, 25, 30, and 35years 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 and concordance statistics 0.70 or greater in 9 and 10 of the 12 models, respectively. For replication, achieved areas under the receiver operating characteristic curve and concordance statistics 0.70 or greater were observed in 7 and 9 of the models, respectively. Across outcomes, the most influential exposures were anthracycline chemotherapy, radiotherapy, diabetes, and hypertension. Survivors were then assigned to statistically distinct risk groups corresponding to cumulative incidences at age 50 years of each target outcome of less than 3% (moderate-risk) or approximately 10% or greater (high-risk). Cumulative incidence of all outcomes was 1% or less among siblings.Conclusions: Traditional cardiovascular risk factors remain important for predicting risk of cardiovascular disease among adult-age survivors of childhood cancer. These prediction models provide a framework on which to base future surveillance strategies and interventions.