Metabolic syndrome and cardiovascular risk among long-term survivors of acute lymphoblastic leukaemia - From the St. Jude Lifetime Cohort

Abstract

Adult survivors of childhood acute lymphoblastic leukaemia (ALL) have a four-fold excess risk of mortality from cardiovascular disease. This cardiovascular risk has not been fully characterized. ALL survivors [n = 784, median age 31·7 years (18·9-59·1)] in the St. Jude Lifetime Cohort Study underwent evaluation for cardiovascular risk and metabolic syndrome (MetS) according to National Cholesterol Education Program - Adult Treatment Panel III criteria. Comparisons were made to 777 age-, sex-, and race-matched controls from the National Health and Nutrition Examination Survey (NHANES). MetS was identified in 259 survivors (33·6%) and associated with older age in 5-year increments (relative risk [RR] 1·13, 95% confidence interval [CI] 1·06-1·19) and prior cranial radiotherapy (CRT) (with craniospinal radiation: RR 1·88, 95%CI 1·32-2·67; without: RR 1·67, 95%CI 1·26-2·23). Measures of obesity were highly prevalent among female survivors and CRT recipients. Compared to NHANES controls, ALL survivors had a higher risk of MetS (RR 1·43, 95%CI 1·22-1·69), hypertension (RR 2·43, 95%CI 2·06-2·86), low high-density lipoprotein (RR 1·40, 95%CI 1·23-1·59), obesity (RR 1·47, 95%CI 1·29-1·68) and insulin resistance (1·64, 95%CI 1·44-1·86). This large study of clinically evaluated ALL survivors identified a high prevalence of MetS, obesity and cardiovascular risk, particularly in CRT recipients, underscoring the need for screening and aggressive reduction of modifiable risks.

Keywords: acute lymphoblastic leukaemia; cardiovascular risk; childhood cancer survivors; cranial radiotherapy; metabolic syndrome.

Figure 1

Recruitment diagram for survivors of acute lymphoblastic leukaemia (ALL) eligible for the St. Jude Lifetime Cohort Study (SJLIFE)

Figure 2

Comparison of cardiovascular risk factors among SJLIFE ALL survivors and age-, sex-, and race-matched NHANES controls SJLIFE, St. Jude Lifetime Cohort Study; NHANES, National Health and Nutrition Examination Survey; BMI, body mass index; CRT, cranial radiation; HDL, high-density lipoprotein; LDL, low-density lipoprotein; LDH, lactate dehydrogenase.