Key result
Family history of atherosclerotic disease is linked to ~38% higher heart failure risk after cardiotoxic therapy.
Why the study?
It was unknown whether family history of cardiovascular disease further increases risk of adverse cardiovascular outcomes among childhood cancer survivors exposed to cardiotoxic therapies.
Cohort (n=1,260)
No
Relative Risk: 1.38 (95% CI 1.01–1.88)
p-value: p=0.04
May inform family history integration into cardiotoxicity surveillance; extends risk models but leaves open prospective validation before practice change.
Background: Survivors of childhood cancer have an increased risk of therapy-related cardiovascular disease. It is not known whether family history of cardiovascular disease further increases risk of adverse cardiovascular outcomes among survivors. Methods: Family history of cardiovascular disease was collected from 1,260 survivors [median age at diagnosis, 8 years (range, 0–23); age at last follow-up, 35 years (range, 18–66)] of childhood cancer in the St. Jude Lifetime Cohort Study. Multivariable risk models evaluated associations with cardiovascular disease (Common Terminology Criteria for Adverse Events grade 2–4 events) and cardiovascular risk factors. Results: Among survivors exposed to chest-directed radiation and/or anthracycline chemotherapy (n = 824), 7% reported a first-degree family history of heart failure, 19% myocardial infarction, 11% stroke, 26% atherosclerotic disease (myocardial infarction and/or stroke), 62% hypertension, and 31% diabetes mellitus. Eighteen percent of exposed survivors developed heart failure, 9% myocardial infarction, 3% stroke, 11% atherosclerotic disease, 30% hypertension, and 9% diabetes mellitus. Having a first-degree family history of atherosclerotic disease was independently associated with development of treatment-related heart failure [RR, 1.38; 95% confidence interval (CI), 1.01–1.88; P = 0.04] among exposed survivors. Risk for hypertension was increased among exposed survivors with a first-degree family history of hypertension (RR, 1.55; 95% CI, 1.26–1.92; P < 0.0001) or of any cardiovascular disease [myocardial infarction, stroke, or heart failure (RR, 1.30; 95% CI, 1.06–1.59; P = 0.01)]. Conclusions: Family history of cardiovascular disease and cardiovascular risk factors independently increased risk of heart failure and hypertension among survivors of childhood cancer exposed to cardiotoxic therapies. Impact: These data show the importance of cardiovascular family history as a risk factor for cardiovascular disease in survivors of childhood cancer.
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Goldberg et al. (2020) conducted a cohort in Childhood cancer survivors (n=1,260). First-degree family history of atherosclerotic disease vs. No first-degree family history of atherosclerotic disease was evaluated on Development of treatment-related heart failure among survivors exposed to cardiotoxic therapies (RR 1.38, 95% CI 1.01-1.88, p=0.04). Having a first-degree family history of atherosclerotic disease independently increased the risk of developing treatment-related heart failure (RR 1.38) among childhood cancer survivors exposed to cardiotoxic therapies.
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