Memorial Sloan Kettering Cancer Center, New York, NY
Darren R. Feldman , Shirin Ardeshir-Rouhani-Fard , Patrick Monahan , Chunkit Fung , Robert James Hamilton , David J. Vaughn , Clair Beard , Kevin C. Oeffinger , Lawrence H. Einhorn , Sophie D. Fossa , Howard D. Sesso , Lois B. Travis
Background: Although significantly increased rates of CVD among GCT survivors following CBCT have been reported in several studies, identifying a high risk subgroup to target with cardiovascular interventions remains challenging. We applied a validated CVD risk prediction model to a large cohort of CBCT-treated male GCT survivors in an ongoing North American multicenter study. Methods: GCT survivors eligible for analysis were men diagnosed at age < 50 y who completed first-line CBCT (≥ 3 cycles) > 1 y before enrollment. Patients completed questionnaires regarding comorbidities, lifestyle behaviors, and prescription drug use. Systolic and diastolic blood pressure (SBP and DBP), waist circumference, and lipids were measured. We used the Framingham model (D’Agostino, Circulation2008) for men to estimate individual 10 y CVD risk (defined as angina, MI, stroke, TIA, claudication or heart failure). Model variables include age, total cholesterol, HDL, SBP, hypertension treatment, diabetes, and smoking status. We excluded men with baseline CVD or missing data for > 1 risk factor. Results: The first 459 eligible GCT survivors enrolled on study were evaluated. Median age was 37.8 y, 15.7% had SBP ≥ 140 mm Hg, 56.0% had total cholesterol > 200 mg/dL, and 16.6% had HDL < 40 mg/dL; 13.1% were on BP medication, 9.6% were current smokers, and 4.1% had diabetes. One in 6 men had a predicted 10 y CVD rate of ≥ 10% (Table), corresponding to classification as intermediate, high, or very high risk and warranting consideration of management of CVD risk factors. CVD risk increased with age at evaluation; those < 30, 30-39, 40-49, 50-59, and ≥ 60 y had 10 y risks of 1.2%, 3.2%, 8.1%, 14.0%, and 22.3%, respectively. Conclusions: The Framingham model identified a sizable proportion of CBCT-treated GCT patients to be at intermediate or higher risk of CVD within 10 y. Clinicians should be aware of these risks since, despite their young median age, such patients may benefit from targeted interventions.
Predicted 10 y Risk of CVD | |||||
---|---|---|---|---|---|
Very Low ( < 5%) | Low (5 –< 10%) | Intermediate (10 –< 20%) | High (20 –< 30%) | Very High ( > 30%) | |
N (%) | 279 (60.8%) | 106 (23.1%) | 51 (11.1%) | 18 (3.9%) | 5 (1.1%) |
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