1. In this study, patients who received treatment for Hodgkin’s Lymphoma had a 3 to 6 fold increased incidence of developing coronary heart disease and heart failure, respectively, compared to the general population.
2. Mediastinal radiotherapy and anthracycline chemotherapy were most associated with increasing the risk of cardiovascular events when evaluating the different therapies that were employed over the years.
Evidence Rating Level: 2 (Good)
Study Rundown: Hodgkin’s Lymphoma (HL) is one of the most curable malignancies. Since most HL patients are young and living longer, more information regarding the aftereffects of the chemotherapy and radiation used in HL is coming to light. Specifically, some studies have found significantly higher cardiovascular disease amongst survivors of HL. This study, which examined Dutch patients who survived HL for several decades afterwards, found that these patients had a 3 to 6 fold increased incidence of developing coronary heart disease and heart failure, respectively, compared to the general population. Mediastinal radiotherapy and anthracycline chemotherapy were the biggest culprits in increasing the risk of cardiovascular events when evaluating the different therapies that were employed through the years.
The major strength of this study is the long follow up period, which allows the natural course of cardiovascular disease to take place. The major weakness is the significant change in therapy of HL over time, which does affect the relevance of findings from one era to the next. Additionally, the cohort population was relatively small and homogenous, so the results may not generalizable.
In-Depth [retrospective cohort]: The study cohort composed of patients who had received HL treatment at five Dutch university hospitals or cancer centers between the years 1965 and 1995, before the age of 51years, and had survived for five years. Information regarding cardiovascular disease and demographic information was obtained by contacting their general practitioners and cardiologists. Cardiovascular disease included coronary heart disease (including myocardial infarctions and angina), valvular heart disease, and heart failure. There were a total of 2,524 patients included in the final analysis. The median age at time of HL diagnosis was 27.3 years, and median follow up was 20.3yrs (range, 5 – 47 years).
There were a total of 1,713 cardiovascular events identified in 797 patients. The results were reported as standardized incidence ratios (SIRs), which are ratios of the observed and expected outcomes. Those who received therapy for HL had a 3.2-fold increased SIR (95% CI, 3.0-3.5) of developing coronary heart disease and a 6.8-fold increased SIR (95% CI, 5.9-7.6) of developing heart failure compared to the general population. Patients treated at a younger age had higher SIRs than patients treated over the age of 35 years. After considering the different therapies employed for HL, mediastinal radiotherapy (HR 3.6; 95% CI, 2.8-4.6) and anthracycline chemotherapy (HR 1.5; 95% CI, 1.2-1.8) had the strongest association with cardiovascular events. Risk appeared to be higher with increasing doses of the chemotherapy and radiotherapy.
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