Vascular Health and Risk Management (Sep 2018)
Arterial elasticity as a risk factor for early cardiovascular disease among testicular cancer survivors treated with platinum-based chemotherapy: a cross-sectional pilot study
Abstract
Anne H Blaes,1 Daniel A Mulrooney,2 Rachel Isaksson Vogel,3 Anna Solovey,1 Robert Hebbel,1 Bruce A Peterson,1 Joseph P Neglia,4 Carter Biewen,5 Suma H Konety,6 Daniel A Duprez6 1Division of Hematology/Oncology, University of Minnesota, Minneapolis, MN, USA; 2St Jude Children’s Research Hospital, Memphis, TN, USA; 3Division of Gynecology/Oncology, University of Minnesota, MN, USA; 4Department of Pediatrics, University of Minnesota, MN, USA; 5Division of Pediatrics, University of California San Francisco, CA, USA; 6Division of Cardiology, University of Minnesota, MN, USA Purpose: Testicular cancer survivors who have received platinum-based chemotherapy are at risk for premature cardiovascular disease. The etiology of this risk is not well understood. This pilot study explores the impact of platinum-based chemotherapy on endothelial function. Methods: Testicular cancer survivors <30 years old at the time of diagnosis who received platinum-based chemotherapy between 2002 and 2012, as well as 17 similarly aged male controls, were identified. Consented subjects underwent vascular assessment using the HDI/PulseWave CR-2000 Cardiovascular Profiling System and the Endo-PAT2000 system. Biomarkers and functional test markers were compared among cases, controls, and a group of historical controls using two sided two-sampled t-tests and Wilcoxon rank-sum tests. Results: Thirteen survivors with a median age of 30.2 years and body mass index of 27.3 were enrolled, along with 17 healthy controls with a median age of 27.1 years and body mass index of 24.8. Median time from chemotherapy was 4.7 (range: 0.8–14) years. There was no statistical difference in reactive hyperemia peripheral arterial tonometry ratio between cases and controls (p = 0.574). There was no statistical difference in small or large artery elasticity between cases and controls (p = 0.086) or between cases and historical controls (p = 0.729). There was also no statistical difference in the blood levels of circulating endothelial cells, von Willebrand factor, and vascular cell adhesion molecules. There was a trend toward increased metabolic syndrome in cases (15%) as compared to recruited controls (6%), though this difference was not statistically significant (p = 0.565). Conclusion: Testicular cancer survivors have no clinically significant difference in endothelial function compared to controls 4 years after the completion of chemotherapy. Further research is needed to explore the secondary modifiable causes that may contribute to the risk of premature cardiovascular disease. Keywords: vascular injury, testicular cancer, chemotherapy, cardio-oncology, cardiac injury, cardiac disease
