People who survive Hodgkin’s lymphoma in adolescence or young adulthood remain at very high risk for cardiovascular disease for at least 40 years – the longest period for which they have been followed, according to the results of a retrospective cohort study of more than 2,500 patients.

Until now, follow-up studies of such patients “rarely exceeded 20-25 years,” before most survivors reached the age at which cardiovascular disease (CVD) becomes commonplace in the general population. To compare CVD rates between survivors and the general population at later ages, investigators examined the medical records of 2,524 individuals who survived 5 years or more after being treated for Hodgkin’s lymphoma as adolescents or young adults at five Dutch medical centers between 1965 and 1995.

A total of 81% of the cohort had received mediastinal radiotherapy and 31% had received anthracycline-containing chemotherapy. After 5-47 years of follow-up, 797 of these patients experienced 1,713 cardiovascular events. The most frequently occurring events included 401 coronary heart disease events (such as myocardial infarction and angina pectoris), 374 valvular heart disease events, and 140 heart failure events (such as cardiomyopathy and congestive heart failure), Frederika A. van Nimwegen of the department of epidemiology, the Netherlands Cancer Institute, Amsterdam, and her colleagues wrote in JAMA Internal Medicine on April 27 (doi:10.1001/jamainternmed.2015.1180).

Compared with the general population, Hodgkin’s survivors had a 3.2-fold higher standardized incidence ratio (SIR) of developing coronary heart disease and a 6.8-fold higher SIR of developing heart failure, corresponding to 70 excess cases of coronary heart disease and 58 excess cases of heart failure per 10,000 person-years.

These risks were significantly higher for survivors than for the general population at all ages, but patients who had been diagnosed and treated before the age of 25 years were at particularly elevated risk: they carried a 4.6- to 7.5-fold higher risk of coronary heart disease and a 10.9- to 40.5-fold higher risk of heart failure. At 40 years after Hodgkin’s diagnosis and treatment, the cumulative incidence of any type of CVD was 50%, the investigators wrote. Both survivors of Hodgkin’s lymphoma and their physicians should be aware that these patients remain at substantially increased cardiovascular risk throughout their lives, Ms. Van Nimwegen and her colleagues wrote.

This study was supported by the Dutch Cancer Society. Ms. van Nimwegen and her colleagues reported having no financial disclosures.


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