Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.
Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee.
Cancer Epidemiol Biomarkers Prev. 2021 Feb;30(2):286-294. doi: 10.1158/1055-9965.EPI-20-1183. Epub 2020 Nov 24.
Childhood cancer survivors are at risk for cardiovascular morbidity and mortality that is not fully explained by cancer-directed therapies. We examined the contribution of emotional stress and distress to cardiac health in adult survivors of childhood cancer.
Participants included 3,267 adult survivors enrolled in the St. Jude Lifetime Cohort Study [median (range) 29.9 (18.1-64.5) years of age; 7.7 (0-24.8) years at diagnosis; 48.4% female]. Survivors completed comprehensive medical assessments and standardized measures of depression, anxiety, posttraumatic stress symptoms (PTSS), and perceived stress. Cardiovascular-related conditions included hypertension, diabetes, dyslipidemia, cardiomyopathy, dysrhythmia, myocardial infarction (severity graded 0-4), and metabolic syndrome (yes/no). Multivariable modified Poisson models examined associations between symptoms of stress/distress and cardiovascular outcomes. Longitudinal associations between stress/distress and new-onset cardiovascular outcomes, defined as a change from grade ≤1 at initial evaluation to grade ≥2 at follow-up (median 3.9 years) were examined in 1,748 participants.
In multivariable cross-sectional models, stress/distress was associated with hypertension [risk ratio (RR) = 1.24; 95% confidence interval (CI), 1.07-1.43], dyslipidemia (RR = 1.29; 95% CI, 1.03-1.61), and metabolic syndrome (RR = 1.35; 95% CI, 1.17-1.54) independent of known cardiovascular risk factors. In longitudinal models, stress/distress was associated with new-onset dysrhythmia (RR = 2.87; 95% CI, 1.21-6.78), perceived stress with hypertension (RR = 1.42; 95% CI, 1.04-1.95), and PTSS and anxiety with dyslipidemia (RR = 1.72; 95% CI, 1.13-2.62; RR = 1.54; 95% CI, 1.01-2.35, respectively).
Stress/distress is independently associated with adverse cardiovascular outcomes among childhood cancer survivors.
Improving psychological health may serve as a potential intervention target for optimizing cardiac health among childhood cancer survivors.
儿童癌症幸存者存在心血管发病率和死亡率的风险，而这些风险不能完全用癌症定向治疗来解释。我们研究了情绪压力和困扰对儿童癌症成年幸存者心脏健康的影响。
参与者包括 3267 名参加圣裘德终身队列研究的成年幸存者[中位数（范围）29.9（18.1-64.5）岁；诊断时 7.7（0-24.8）岁；48.4%为女性]。幸存者完成了全面的医疗评估和抑郁、焦虑、创伤后应激症状（PTSS）和感知压力的标准化测量。心血管相关疾病包括高血压、糖尿病、血脂异常、心肌病、心律失常、心肌梗死（严重程度 0-4 级）和代谢综合征（是/否）。多变量修正泊松模型研究了压力/困扰与心血管结果之间的关联。在 1748 名参与者中，检查了压力/困扰与新发心血管结局之间的纵向关联，新发心血管结局定义为在初始评估时等级≤1 到随访时等级≥2 的变化（中位数为 3.9 年）。
在多变量横断面模型中，压力/困扰与高血压[风险比（RR）=1.24；95%置信区间（CI），1.07-1.43]、血脂异常（RR=1.29；95%CI，1.03-1.61）和代谢综合征（RR=1.35；95%CI，1.17-1.54）独立于已知的心血管危险因素相关。在纵向模型中，压力/困扰与新发心律失常相关（RR=2.87；95%CI，1.21-6.78），感知压力与高血压相关（RR=1.42；95%CI，1.04-1.95），PTSS 和焦虑与血脂异常相关（RR=1.72；95%CI，1.13-2.62；RR=1.54；95%CI，1.01-2.35）。
压力/困扰与儿童癌症幸存者不良心血管结局独立相关。
改善心理健康可能是优化儿童癌症幸存者心脏健康的潜在干预目标。
