Cardiovascular risk factors, radiation therapy, and myocardial infarction among lymphoma survivors.
Cardiovascular risk factors, radiation therapy, and myocardial infarction among lymphoma survivors.
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DOI：
10.1080/0284186x.2022.2107402
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发表时间：
2022-09
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纵隔放射与非霍奇金淋巴瘤（NHL）幸存者心肌梗死（MI）风险增加相关。评价既存心血管风险因素（CVRF）如何改变全国NHL幸存者人群中纵隔放射和MI与一系列CVRF的相关性。使用丹麦登记处，我们确定了2000-2010年诊断为淋巴瘤的成年人。我们评估了从诊断后一年到2016年的MI。我们确定了CVRF（高血压、血脂异常和糖尿病）、血管疾病和内在心脏病在淋巴瘤诊断中的流行情况。我们使用多变量考克斯回归来检验既存CVRF和接受纵隔放疗对随后MI的相互作用。在3151名NHL幸存者（中位年龄63岁，中位随访6.5年）中，96名被诊断为MI。在淋巴瘤发生前，32%的存活者有≥1个CVRF。8.5%的幸存者接受了纵隔放射治疗。在多变量分析中，我们发现纵隔放射（HR=1.96; 95% CI=1.09-3.52）和存在≥1个CVRF（HR=2.71; 95% CI=1.77-4.15）与MI风险增加相关。尽管在相对量表上没有相互作用（p=0.14），但我们观察到CVRF患者的临床相关绝对风险增加，从未接受放射治疗的10年MI的10.5%增加到接受放射治疗的29.5%。CVRF患者如果接受纵隔放射治疗，则后续MI的风险显著升高。接受癌症治疗后，应继续常规评估CVRF和对既存心血管疾病进行最佳治疗。对于CVRF患者，只有在肿瘤学获益明显超过心血管损害时才应给予纵隔放疗。
Mediastinal radiation is associated with increased risk of myocardial infarction (MI) among non-Hodgkin lymphoma (NHL) survivors. To evaluate how pre-existing cardiovascular risk factors (CVRFs) modify the association of mediastinal radiation and MI among a national population of NHL survivors with a range of CVRFs. Using Danish registries, we identified adults diagnosed with lymphoma 2000-2010. We assessed MI from one year after diagnosis through 2016. We ascertained CVRFs (hypertension, dyslipidemia, and diabetes), vascular disease, and intrinsic heart disease prevalent at lymphoma diagnosis. We used multivariable Cox regression to test the interaction between pre-existing CVRFs and receipt of mediastinal radiation on subsequent MI. Among 3151 NHL survivors (median age 63, median follow-up 6.5 years), 96 were diagnosed with MI. Before lymphoma, 32% of survivors had ≥1 CVRF. 8.5% of survivors received mediastinal radiation. In multivariable analysis, we found that mediastinal radiation (HR=1.96; 95% CI=1.09-3.52), and presence of ≥1 CVRF (HR=2.71; 95% CI=1.77-4.15) were associated with an increased risk of MI. Although there was no interaction on the relative scale (p=0.14), we saw a clinically relevant absolute increase in risk for patients with CVRF from 10-year of MI of 10.5% without radiation to 29.5% for those undergoing radiation. Patients with CVRFs have an importantly higher risk of subsequent MI if they have mediastinal radiation. Routine evaluation of CVRFs and optimal treatment of pre-existing cardiovascular disease should continue after receiving cancer therapy. In patients with CVRFs, mediastinal radiation should only be given if oncologic benefit clearly outweighs cardiovascular harm.