Cardiovascular risk factors, radiation therapy, and myocardial infarction among lymphoma survivors

Authors

  • Talya Salz Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
  • Emily C. Zabor Department of Quantitative Health Sciences & Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
  • Peter De Nully Brown Department of Hematology, Rigshospitalet, Copenhagen, Denmark
  • Susanne Oksbjerg Dalton Danish Cancer Society Research Center, Copenhagen, Denmark
  • Nirupa J. Raghunathan Department of General Internal Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
  • Matthew J. Matasar Lymphoma Survivorship Clinic, Memorial Sloan Kettering Cancer Center, New York, NY, USA
  • Richard Steingart Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
  • Henrik Hjalgrim Statens Serum Institute, Copenhagen, Denmark
  • Lena Specht Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
  • Andrew J. Vickers Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
  • Kevin C. Oeffinger Department of Medicine, Duke Cancer Institute, Durham, NC, USA
  • Christoffer Johansen CASTLE – Cancer Late Effect Research, Oncology Clinic, Center for Surgery and Cancer, Copenhagen, Denmark

DOI:

https://doi.org/10.1080/0284186X.2022.2107402

Keywords:

Lymphoma, ancer survivorship, ardiovascular disease, myocardial infarction, radiation therapy

Abstract

Background

Mediastinal radiation is associated with increased risk of myocardial infarction (MI) among non-Hodgkin lymphoma (NHL) survivors.

Objective

To evaluate how preexisting cardiovascular risk factors (CVRFs) modify the association of mediastinal radiation and MI among a national population of NHL survivors with a range of CVRFs.

Material and methods

Using Danish registries, we identified adults diagnosed with lymphoma 2000–2010. We assessed MI from one year after diagnosis through 2016. We ascertained CVRFs (hypertension, dyslipidemia, and diabetes), vascular disease, and intrinsic heart disease prevalent at lymphoma diagnosis. We used multivariable Cox regression to test the interaction between preexisting CVRFs and receipt of mediastinal radiation on subsequent MI.

Results

Among 3151 NHL survivors (median age 63, median follow-up 6.5 years), 96 were diagnosed with MI. Before lymphoma, 32% of survivors had ≥1 CVRF. 8.5% of survivors received mediastinal radiation. In multivariable analysis, we found that mediastinal radiation (HR = 1.96; 95% CI = 1.09–3.52), and presence of ≥1 CVRF (HR = 2.71; 95% CI = 1.77–4.15) were associated with an increased risk of MI. Although there was no interaction on the relative scale (p = 0.14), we saw a clinically relevant absolute increase in risk for patients with CVRF from 10-year of MI of 10.5% without radiation to 29.5% for those undergoing radiation.

Conclusion

Patients with CVRFs have an importantly higher risk of subsequent MI if they have mediastinal radiation. Routine evaluation of CVRFs and optimal treatment of preexisting cardiovascular disease should continue after receiving cancer therapy. In patients with CVRFs, mediastinal radiation should only be given if oncologic benefit clearly outweighs cardiovascular harm.

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Published

2023-10-16

How to Cite

Salz, T., Zabor, E. C., De Nully Brown, P., Oksbjerg Dalton, S., Raghunathan, N. J., Matasar, M. J., … Johansen, C. (2023). Cardiovascular risk factors, radiation therapy, and myocardial infarction among lymphoma survivors. Acta Oncologica, 61(9), 1064–1068. https://doi.org/10.1080/0284186X.2022.2107402