Cardiovascular risk factors, NT-proBNP levels and echocardiographic findings in long-term survivors of childhood cancer exposed to anthracyclines

Purpose To describe cardiovascular risk factors, cardiac biomarkers, and conventional echocardiographic findings in long-term childhood cancer survivors exposed to anthracyclines and to explore associations with treatment-related exposures. Methods This retrospective cross-sectional single-center study included 97 long-term childhood cancer survivors exposed to anthracyclines, with or without thoracic radiotherapy. Cardiovascular risk factors and biomarkers were assessed during 2024–2025. Echocardiographic data were obtained retrospectively from the most recent examination performed during routine follow-up and were not contemporaneous with biomarker assessment. Anthracycline exposure was converted to doxorubicin-equivalent dose. Results Median time since completion of cancer treatment was 13.7 years. Overweight/obesity was present in 29.9% of survivors, elevated or hypertensive-range blood pressure in 49.5%, hypercholesterolemia in 21.6%, and physical inactivity in 20.6%. Reduced left ventricular systolic function was identified in 1 of 85 survivors with available echocardiography (1.2%). Higher cumulative anthracycline exposure was associated with higher NT-proBNP concentrations (Spearman’s ρ = 0.38, p < 0.001). After adjustment for age, sex, body mass index, and renal function, each 100 mg/m² increase in doxorubicin-equivalent dose was associated with a 12.2 pg/mL higher median NT-proBNP concentration (95% CI 6.7–17.7; p < 0.001). No significant association was observed between anthracycline exposure and left ventricular ejection fraction. Conclusions Cardiovascular risk factors were common, whereas conventional echocardiographic findings were largely preserved. Higher cumulative anthracycline exposure was associated with higher NT-proBNP concentrations, although the clinical significance of this finding remains uncertain. Implications for cancer survivors Survivorship care should include systematic assessment of modifiable cardiovascular risk factors. Prospective studies using contemporaneous biomarkers and advanced cardiac imaging are needed to better characterize long-term cardiovascular risk.