Key result
Childhood cancer survivors face ~7.3-fold higher post-heart failure mortality compared to siblings.
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Why the study?
Adult survivors of childhood cancer are at risk for cardiovascular events, but their mortality risk after major cardiovascular events compared with non-cancer populations was unclear.
Cohort (n=35,823)
Yes
Hazard Ratio: 7.32 (95% CI 2.56–20.89)
Absolute Event Rate: 30% vs 14%
p-value: p=<0.001
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“We found that the risk of death after a major cardiovascular event in a 50-year-old in the general population is equivalent to that of a 30-year-old who was previously treated for cancer as a child. Untreated risk factors have a larger impact on risk for death following a serious heart event among survivors of childhood cancer relative to the general population, and therefore we shouldn't just assume that because someone is young they don't need risk factors like high blood pressure or high cholesterol treated.”
Survivors of childhood cancer who experience a major cardiovascular event have a substantially higher mortality risk compared with non-cancer populations, indicating a need for optimized preventative strategies and specialized cardiovascular care.
Background: Adult survivors of childhood cancer are at risk for cardiovascular events. Objective: To determine the risk for mortality after a major cardiovascular event among survivors compared with non-cancer populations. Methods: All-cause and cardiovascular cause-specific mortality risks after heart failure (HF), coronary artery disease (CAD), or stroke were compared among survivors and siblings in the Childhood Cancer Survivor Study (CCSS) and participants in the Coronary Artery Risk Development in Young Adults (CARDIA) study. Cox proportional hazards regression models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) between groups, adjusted for demographic and clinical factors. Results: Among 25,658 childhood cancer survivors (median age at diagnosis 7 years, median age at follow-up/death 38 years), and 5,051 siblings, 1,780 survivors and 91 siblings had a cardiovascular event. Following HF, CAD, or stroke, 10-year all-cause mortality was 30% (CI: 26-33%); 36% (CI: 31-40%); and 29% (CI: 24-33%) respectively among survivors versus 14% (CI: 0-25%); 14% (CI: 2-25%); and 4% (CI: 0-11%) among siblings. All-cause mortality risks among survivors were increased after HF (HR=7.32, CI: 2.56-20.89), CAD (HR=5.54, CI: 2.37-12.93), and stroke (HR=3.57, CI: 1.12-11.37). CAD-specific mortality risk was increased (HR=3.70, CI: 1.05-13.02). Among 5,114 CARDIA participants, 345 had a major event. While CARDIA participants were on average decades older at events (median age 57 years versus 31 years), mortality risks were similar, except all-cause mortality after CAD was significantly increased among survivors (HR=1.85, CI: 1.16-2.95). Conclusions: Survivors of childhood cancer represent a population at high risk for mortality after major cardiovascular events.
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Bottinor et al. (2024) conducted a cohort in Survivors of childhood cancer who experience a major cardiovascular event (n=35,823). Childhood cancer survivorship (exposure to cancer therapies) vs. Non-cancer populations (siblings and CARDIA participants) was evaluated on All-cause mortality after heart failure (HR 7.32, 95% CI 2.56-20.89, p=<0.001). Childhood cancer survivors had a significantly increased risk of all-cause mortality following heart failure compared to siblings (HR 7.32, 95% CI 2.56-20.89).
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