1.1 PROMOTION OF ARTERIAL STIFFNESS BY CHILDHOOD CANCER AND ITS CHARACTERISTICS IN ADULT LONG-TERM SURVIVORS

Abstract

Background: Vascular alterations induced by antineoplastic treatment might be considered as a possible underlying mechanism of increased cardiovascular (CV) sequelae in childhood cancer survivors (CCS). Therefore, we thought to evaluate the changes in arterial stiffness (AS) among long-term CCS compared to the general population. Methods: AS was assessed by digital photoplethysmography (Stiffness Index (SI); m/s) among 1,002 participant of “Cardiac and Vascular late Sequelae in long-term Survivors of childhood cancer” study, diagnosed with neoplasia prior to an age of 15 years (1980–1990). A population-based subsample from the Gutenberg Health Study (GHS) (n = 5,252) was used for comparison. All subjects underwent a comprehensive, standardized clinical examination in the same study center. Results: Compared to the population subsample with similar age range, CCS had higher SI in multivariable linear regression analysis with adjustment for cardiovascular risk factor and comorbidities (β = 0.66[0.51/0.80]; p < 0.0001). Moreover, SI was varying according to tumor entity with highest values in bone tumors. Interestingly, CCS demonstrated stiffer vessels than individuals from the population even in absence of a history of chemo- or radiotherapy (β = 0.56[0.16/0.96]; p = 0.0066) or prevalent hypertension (β = 0.66[0.50/0.81]; p < 0.0001) in fully-adjusted models. Finally, a 5.2-fold [3.9; 7.0] higher prevalence of SI values exceeding age-specific, population-based reference limits was observed among CCS compared to individuals from the population. Conclusions: This is the first study demonstrating increased AS among long-term CCS. The data suggest that AS promotion might differ in individuals with childhood cancer: Cancer development and antineoplastic treatment might be relevant determinants.