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Risk of cardiovascular disease among Nordic childhood cancer survivors with diabetes mellitus : A report from adult life after childhood cancer in Scandinavia

, ; Winther, Jeanette F.; Bhatia, Smita; Cederkvist, Luise; Gudmundsdottir, Thorgerdur; Madanat-Harjuoja, Laura; Tryggvadottir, Laufey; Wesenberg, Finn; Hasle, Henrik and Sällfors Holmqvist, Anna LU (2018) In Cancer 124(22). p.4393-4400
Abstract

BACKGROUND: Childhood cancer survivors have an increased risk of cardiovascular disease (CVD) and diabetes mellitus. Because diabetes is a potentially modifiable risk factor for CVD in the general population, it is important to understand how diabetes affects the risk of CVD among childhood cancer survivors. METHODS: This study examined the risk of CVD among survivors with diabetes and 142,742 population comparison subjects. From the national cancer registries of the 5 Nordic countries, 29,324 one-year survivors of cancer diagnosed before the age of 20 years between 1968 and 2008 were identified. Study subjects were linked to the national hospital registers. The cumulative incidence of CVD was determined with competing risk methods. A... (More)

BACKGROUND: Childhood cancer survivors have an increased risk of cardiovascular disease (CVD) and diabetes mellitus. Because diabetes is a potentially modifiable risk factor for CVD in the general population, it is important to understand how diabetes affects the risk of CVD among childhood cancer survivors. METHODS: This study examined the risk of CVD among survivors with diabetes and 142,742 population comparison subjects. From the national cancer registries of the 5 Nordic countries, 29,324 one-year survivors of cancer diagnosed before the age of 20 years between 1968 and 2008 were identified. Study subjects were linked to the national hospital registers. The cumulative incidence of CVD was determined with competing risk methods. A Cox proportional hazards model was used to estimate the effects of diabetes and cancer on the hazard of CVD. The interaction between diabetes and cancer was analyzed. RESULTS: Diabetes was diagnosed in 324 of the 29,324 one-year survivors, and CVD was diagnosed in 2108. The hazard of diabetes was 1.7 times higher among survivors than comparison subjects (hazard ratio [HR], 1.7; 95% confidence interval [CI], 1.5-1.9), whereas the HR of CVD was 3.6 (95% CI, 3.3-3.8) 1 to 15 years after the cancer diagnosis and 1.9 (95% CI, 1.8-2.0) after more than 15 years. Individuals with diabetes had a 2.4 times higher hazard of CVD (95% CI, 2.1-2.8) among both survivors and comparison subjects in comparison with individuals without diabetes. CONCLUSIONS: Childhood cancer survivors with diabetes have a markedly increased risk of CVD in comparison with survivors without diabetes. However, diabetes does not increase the risk of CVD more in survivors than the general population.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
cardiovascular disease, cerebrovascular disease, childhood cancer, diabetes mellitus, survivorship
in
Cancer
volume
124
issue
22
pages
4393 - 4400
publisher
John Wiley & Sons
external identifiers
  • scopus:85054735660
ISSN
0008-543X
DOI
10.1002/cncr.31696
language
English
LU publication?
yes
id
649170bc-4b48-4e8d-8070-530e92ea018a
date added to LUP
2018-11-02 13:09:50
date last changed
2019-02-20 11:34:23
@article{649170bc-4b48-4e8d-8070-530e92ea018a,
  abstract     = {<p>BACKGROUND: Childhood cancer survivors have an increased risk of cardiovascular disease (CVD) and diabetes mellitus. Because diabetes is a potentially modifiable risk factor for CVD in the general population, it is important to understand how diabetes affects the risk of CVD among childhood cancer survivors. METHODS: This study examined the risk of CVD among survivors with diabetes and 142,742 population comparison subjects. From the national cancer registries of the 5 Nordic countries, 29,324 one-year survivors of cancer diagnosed before the age of 20 years between 1968 and 2008 were identified. Study subjects were linked to the national hospital registers. The cumulative incidence of CVD was determined with competing risk methods. A Cox proportional hazards model was used to estimate the effects of diabetes and cancer on the hazard of CVD. The interaction between diabetes and cancer was analyzed. RESULTS: Diabetes was diagnosed in 324 of the 29,324 one-year survivors, and CVD was diagnosed in 2108. The hazard of diabetes was 1.7 times higher among survivors than comparison subjects (hazard ratio [HR], 1.7; 95% confidence interval [CI], 1.5-1.9), whereas the HR of CVD was 3.6 (95% CI, 3.3-3.8) 1 to 15 years after the cancer diagnosis and 1.9 (95% CI, 1.8-2.0) after more than 15 years. Individuals with diabetes had a 2.4 times higher hazard of CVD (95% CI, 2.1-2.8) among both survivors and comparison subjects in comparison with individuals without diabetes. CONCLUSIONS: Childhood cancer survivors with diabetes have a markedly increased risk of CVD in comparison with survivors without diabetes. However, diabetes does not increase the risk of CVD more in survivors than the general population.</p>},
  author       = {,  and Winther, Jeanette F. and Bhatia, Smita and Cederkvist, Luise and Gudmundsdottir, Thorgerdur and Madanat-Harjuoja, Laura and Tryggvadottir, Laufey and Wesenberg, Finn and Hasle, Henrik and Sällfors Holmqvist, Anna},
  issn         = {0008-543X},
  keyword      = {cardiovascular disease,cerebrovascular disease,childhood cancer,diabetes mellitus,survivorship},
  language     = {eng},
  month        = {10},
  number       = {22},
  pages        = {4393--4400},
  publisher    = {John Wiley & Sons},
  series       = {Cancer},
  title        = {Risk of cardiovascular disease among Nordic childhood cancer survivors with diabetes mellitus : A report from adult life after childhood cancer in Scandinavia},
  url          = {http://dx.doi.org/10.1002/cncr.31696},
  volume       = {124},
  year         = {2018},
}