Polomski Elissa A S, Heemelaar Julius C, de Graaf Michiel A, Krol Augustinus D G, Louwerens Marloes, Stöger J Lauran, van Dijkman Paul R M, Schalij Martin J, Jukema J Wouter, Antoni M Louisa
Department of Cardiology, Heart Lung Center, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands.
Department of Radiotherapy, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands.
Cancers (Basel). 2023 Dec 13;15(24):5831. doi: 10.3390/cancers15245831.
Thoracic radiotherapy is one of the corner stones of HL treatment, but it is associated with increased risk of cardiovascular events. As HL is often diagnosed at a young age, long-term follow-up including screening for coronary artery disease (CAD) is recommended.
This study aims to evaluate the presence of coronary artery calcium score (CACS) in relation to cardiovascular events in HL patients treated with thoracic radiotherapy compared to a non-cancer control group.
Consecutive HL patients who underwent evaluation for asymptomatic CAD with coronary computed tomography angiography > 10 years after thoracic irradiation were included. The study population consisted of 97 HL patients matched to 97 non-cancer patients on gender, age, cardiovascular risk factors, and statin use.
Mean age during CT scan in the HL population was 45.5 ± 9.9 and in the non-cancer population 45.5 ± 10.3 years. CACS was elevated (defined as >0) in 49 (50.5%) HL patients and 30 (30.9%) control patients. HL survivors had an odds ratio of 2.28 [95% CI: 1.22-4.28] for having a CACS > 0 compared to the matched population ( = 0.006). Prevalence of CACS > 90th percentile differed significantly: 17.1% in HL survivors vs. 4.6% in the matched population ( 0.009). Non-obstructive coronary artery stenosis was more prevalent in the HL population than in the control population (45.7% vs. 28.4%, respectively, = 0.01). During follow-up of 8.5 [5.3; 9.9] years, nine HL patients experienced an event including two patients with a CACS of zero. No events occurred in the control population.
In a matched study population, HL survivors have a higher prevalence of a CACS > 0 and an increased risk of cardiovascular events after thoracic irradiation compared to a matched non-cancer control group.
胸部放疗是霍奇金淋巴瘤（HL）治疗的基石之一，但它与心血管事件风险增加相关。由于HL常于年轻时被诊断，因此建议进行长期随访，包括筛查冠状动脉疾病（CAD）。
本研究旨在评估接受胸部放疗的HL患者与非癌症对照组相比，冠状动脉钙化评分（CACS）与心血管事件的关系。
纳入在胸部放疗10年以上后接受冠状动脉计算机断层扫描血管造影以评估无症状CAD的连续HL患者。研究人群包括97例HL患者，这些患者在性别、年龄、心血管危险因素和他汀类药物使用方面与97例非癌症患者相匹配。
HL人群CT扫描时的平均年龄为45.5±9.9岁，非癌症人群为45.5±10.3岁。49例（50.5%）HL患者和30例（30.9%）对照患者的CACS升高（定义为>0）。与匹配人群相比，HL幸存者CACS>0的比值比为2.28[95%CI：1.22-4.28]（P=0.006）。CACS>第90百分位数的患病率差异显著：HL幸存者为17.1%，匹配人群为4.6%（P=0.009）。非阻塞性冠状动脉狭窄在HL人群中比在对照人群中更常见（分别为45.7%和28.4%，P=0.01）。在8.5[5.3；9.9]年的随访期间，9例HL患者发生了事件，其中2例患者CACS为零。对照人群未发生事件。
在匹配的研究人群中，与匹配的非癌症对照组相比，HL幸存者CACS>0的患病率更高，胸部放疗后心血管事件风险增加。
