Lifestyle factors and subsequent ischemic heart disease risk after hematopoietic cell transplantation

• Published in: Cancer Vol. 124; no. 7; pp. 1507 - 1515
• Main Authors: Leger, Kasey J., Baker, K. Scott, Cushing‐Haugen, Kara L., Flowers, Mary E. D., Leisenring, Wendy M., Martin, Paul J., Mendoza, Jason A., Reding, Kerryn W., Syrjala, Karen L., Lee, Stephanie J., Chow, Eric J.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.04.2018
• Subjects: Cancer; Cardiovascular disease; Cardiovascular diseases; Confidence intervals; Coronary artery disease; Diabetes mellitus; Dyslipidemia; Health risk assessment; Health risks; healthy lifestyle; Heart; Heart diseases; Heart transplantation; hematopoietic stem cell transplantation; Ischemia; Lifestyles; long‐term survivors; Mortality; myocardial ischemia; Oncology; Physical activity; Risk analysis; Risk factors; Risk taking; Stem cell transplantation; Transplantation; Transplants & implants; hematopoietic stem cell transplantation; mortality; myocardial ischemia; healthy lifestyle; long-term survivors
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.31227

BACKGROUND The objective of this study was to evaluate whether modifiable cardiovascular risk conditions and lifestyle factors were temporally associated with an increased risk for ischemic heart disease and overall mortality in a cohort of hematopoietic cell transplantation (HCT) survivors. METHODS HCT recipients who had survived for ≥1 year, were ≥20 years old, and had undergone transplantation between 1970 and 2010 at a transplant referral center were surveyed in 2010‐2011 about cardiovascular health and lifestyle factors (n = 3833). Respondents (n = 2360 [61.6%]) were followed to 2016 for incident ischemic heart disease and overall mortality. RESULTS Among the 2360 transplant survivors (median age at the baseline survey, 55.9 years; median time since transplantation, 10.8 years), 162 (6.9%) reported ischemic heart disease at the baseline survey. Among those without ischemic heart disease at the baseline survey (n = 2198), the 5‐year cumulative incidence of subsequent ischemic heart disease was 4.3%. Obesity, dyslipidemia, diabetes, and physical inactivity at baseline were associated with an increased risk for subsequent ischemic heart disease (hazard ratio [HRs] ≥ 1.8). Greater physical activity and fruit/vegetable intake at baseline were associated with subsequent lower overall mortality (HRs ≤ 0.7). When jointly considered, each additional cardiovascular risk condition and each adverse lifestyle factor were independently associated with subsequent ischemic heart disease (HR for risk conditions, 1.4; 95% confidence interval [CI], 1.0‐1.9; HR for lifestyle factors, 1.9; 95% CI, 1.2‐2.9), and adverse lifestyle factors remained associated with overall mortality (HR, 1.8; 95% CI, 1.5‐2.3). CONCLUSIONS These results support strong efforts to promote healthy lifestyle behaviors and to treat cardiovascular risk factors aggressively in HCT survivors. This may reduce future ischemic heart disease and overall mortality in this high‐risk population. Cancer 2018;124:1507‐15. © 2018 American Cancer Society. Lifestyle factors remain strongly associated with increased ischemic heart disease and overall mortality in hematopoietic cell transplant survivors. The burden of heart disease may be reduced by the promotion of healthier lifestyles.