Prevalence and determinants of dyslipidemia in 2,338 Dutch childhood cancer survivors: a DCCS-LATER 2 Study

M Bolier, V G Pluimakers, D T C de Winter, M Fiocco, S A A van den Berg, D Bresters, E van Dulmen-den Broeder, M van der Heiden-van der Loo, I Höfer, G O Janssens, L C M Kremer, J J Loonen, M Louwerens, H J van der Pal, S M F Pluijm, W J E Tissing, H M van Santen, A C H de Vries, A J van der Lely, M M van den Heuvel-EibrinkS J C M M Neggers

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Abstract

Objective: Childhood cancer survivors (CCS) face an increased risk of early cardiovascular disease (CVD). In our nationwide CCS cohort, we assessed the prevalence and determinants of dyslipidemia, a well-established risk factor for accelerated atherosclerosis and CVD. Methods: Prevalence of dyslipidemia was cross-sectionally assessed in 2338 adult CCS and compared to adults with no cancer history (Lifelines, n = 132 226). Dyslipidemia was defined by multiple classifications as well as lipid abnormalities to investigate the impact on prevalence and determinants. Logistic regression models, adjusted for age, sex, and BMI, were used to assess the cohort effect on presence of dyslipidemia. Determinants of dyslipidemia were identified through multivariable logistic regression. Results: CCS (median age 34.7 year, median follow-up 27.1 year) had significantly increased odds of dyslipidemia compared to the reference cohort according to all classifications (NCEP-ATP-III, WHO, EGIR, CTCAEv.4.03). In survivors without lipid-lowering agents (n = 2007), lipid abnormalities were present in 20.6% (triglycerides > 1.7 mmol/L), 30.3% (HDL-c < 1.0/1.3 mmol/L (male/female)), 29.9% (total cholesterol > 5.2 mmol/L), 7.3% (LDL-c > 4.1 mmol/L), and 7.7% (apolipoprotein-B > 130 mg/dL). Compared to references without lipid-lowering agents (n = 126 631), survivors had increased odds of high triglycerides (aOR = 1.89, 95% CI = 1.68-2.13), low HDL-c (aOR = 2.73, 95% CI = 2.46-3.03), and high apolipoprotein-B (aOR = 1.84, 95% CI = 1.53-2.20). Sex, age, BMI, physical activity, abdominal/pelvic, cranial, and total body irradiation, alkylating agents, smoking, growth hormone deficiency, and diabetes mellitus were associated with (≥1 definition of) dyslipidemia in CCS. Conclusions: CCS is at increased risk of dyslipidemia, with various modifiable and non-modifiable determinants identified, underscoring the importance of survivor-specific risk assessment tools to control cardiovascular morbidity and mortality in this high-risk population.

Original languageEnglish
Pages (from-to)588-603
Number of pages16
JournalEuropean Journal of Endocrinology
Volume191
Issue number6
Early online date20 Nov 2024
DOIs
Publication statusPublished - 1 Dec 2024

Keywords

  • atherosclerosis
  • childhood cancer survivor
  • dyslipidemia
  • late adverse effect
  • lipids

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