A B S T R A C T PurposeTo determine whether cardiovascular abnormalities in childhood cancer survivors are restricted to patients exposed to cardiotoxic anthracyclines and cardiac irradiation and how risk factors for atherosclerotic disease and systemic inflammation contribute to global cardiovascular status. MethodsWe assessed echocardiographic characteristics and atherosclerotic disease risk in 201 survivors of childhood cancer with and without exposure to cardiotoxic treatments at a median of 11 years after diagnosis (range, 3 to 32 years) and in 76 sibling controls. ResultsThe 156 exposed survivors had below normal left ventricular (LV) mass, wall thickness, contractility, and fractional shortening and above normal LV afterload. The 45 unexposed survivors also had below normal LV mass overall, and females had below normal LV wall thickness. Exposed and unexposed survivors, compared with siblings, had higher levels of N-terminal pro-brain natriuretic peptide (81.7 and 69.0 pg/mL, respectively, v 39.4 pg/mL), higher mean fasting serum levels of non-high-density lipoprotein cholesterol (126.5 and 121.1 mg/dL, respectively, v 109.8 mg/dL), higher insulin levels (10.4 and 10.5 U/mL, respectively, v 8.2 U/mL), and higher levels of high-sensitivity C-reactive protein (2.7 and 3.1 mg/L, respectively, v 0.9 mg/L; P Ͻ .001 for all comparisons). Age-adjusted, predicted-to-ideal 30-year risk of myocardial infarction, stroke, or coronary death was also higher for exposed and unexposed survivors compared with siblings (2.16 and 2.12, respectively, v 1.70; P Ͻ .01 for both comparisons). ConclusionChildhood cancer survivors not receiving cardiotoxic treatments nevertheless have cardiovascular abnormalities, systemic inflammation, and an increased risk of atherosclerotic disease. Survivorship guidelines should address cardiovascular concerns, including the risk of atherosclerotic disease and systemic inflammation, in exposed and unexposed survivors.

Background Adiposity and diseases associated with it, including cardiovascular disease, are emerging long-term complications of pediatric cancer survivors. Direct evaluations of adiposity and comparisons to contemporary controls that can differentiate recent trends in obesity from cancer-related treatments and sequelae are limited. Methods We evaluated demographic, treatment, lifestyle, and endocrine factors at the time of dual energy x-ray absorptiometry testing in 170 non-Hispanic white survivors and 71 sibling controls and compared three measures of adiposity (body mass index [BMI], total body fat, trunk fat). For the survivors alone, we determined factors independently associated with BMI and body fat. Results Survivors were 12 years since diagnosis; 58% had leukemia or lymphoma. BMI did not differ between groups. Among males, body fat was greater in survivors than in controls, (25.8% vs. 20.7%; P=0.007), as was trunk fat (26.7% vs 21.3%; P=0.008). Total or trunk fat did not differ among females. Cholesterol, triglycerides, LDL-cholesterol, and television-viewing hours were higher among male survivors than in controls. Independent factors associated with higher BMI, total and trunk fat included any cranial radiation and television-viewing hours, while prior treatment with cyclophosphamide was associated with lower BMI and body fat measures. Conclusions Compared to siblings, male survivors have greater body fat and metabolic risks. Cranial irradiation and television hours are important risk factors for adiposity in pediatric cancer survivors. Impact Pediatric cancer survivors should be carefully monitored for cardiovascular risk factors and sedentary lifestyles.