Clinical response to lifestyle counseling for dyslipidemia and elevated blood pressure in childhood cancer survivors

Abstract

Background Childhood cancer survivors (CCS) have increased risk of premature cardiovascular disease. Whether they respond similarly to lifestyle changes for elevated blood pressure (BP), body mass index (BMI), and dyslipidemia to those without history of childhood cancer is unknown. Procedure This retrospective cohort study included CCS and 3:1 age‐ and sex‐matched controls treated at Boston Children's Hospital Preventive Cardiology (2010–2019) using lifestyle management based on National Heart, Lung, and Blood Institute (NHLBI) guidelines. Change in BMI, BP, and lipids were analyzed. Results We included 52 CCS and 162 controls with a median age of approximately 16 years. More CCS (84.3%) had elevated baseline fasting triglycerides (TG) than controls (49.4%) (p < .001). More CCS (62.5%) also had abnormal baseline high‐density lipoprotein cholesterol (HDL‐C) compared to controls (35.2%) (p = .001). Baseline BMI, BP, total cholesterol (TC), and low‐density lipoprotein cholesterol (LDL‐C) were similar between groups. Over 15 weeks [IQR: 10.5–26], CCS had greater decrease in TG than controls (72.5 vs. 17 mg/dl decrease, p = .095). BP improved in 5% of CCS versus 38% of controls (p = .008). For both, BMI, TC, LDL‐C, and HDL‐C remained stable. CCS with stem cell transplantation (SCT) had a TC increase of 5% (6 mg/dl) compared to a decrease of 9% (19 mg/dl) among CCS without SCT (p = .02). Conclusions CCS demonstrated similar improvement in lipids, but impaired BP lowering in response to lifestyle management compared to controls. Further prospective studies are needed to determine if earlier pharmaceutical treatment is warranted in this higher risk population and for the long‐term risk reductions of these approaches.

Modifiable Cardiometabolic Risk Factors in Survivors of Childhood Cancer

“…Generalizability of any intervention to a primary care setting must consider regional, cultural, and socioeconomic factors and draw on expertise from dissemination and implementation science. Moreover, evidence on the importance of tailoring lifestyle interventions to survivorship 77 brings into question the translation of pharmacotherapy guidelines from the general population to survivors, necessitating survivor-specific trials with novel study designs to evaluate the safety and effectiveness of available treatments in this unique patient population.…”

“…For managing dyslipidemia in survivors, a retrospective study observed improved triglyceride levels in survivors in response to adopting lifestyle modifications guidelines from the general pediatric population. 77 However, among the trials listed in Supplemental Table 1 , those measuring lipid levels as a secondary outcome did not report significant changes regardless of the effect on weight. 60 , 62 , 63 , 65 , 78 , 79 …”

“…As for management, failure to demonstrate improvement in blood pressure among childhood cancer survivors participating in 2 lifestyle interventions adapted from the general population emphasizes the need for tailored treatments for this group. 77 , 78 Because obesity is an important contributor to hypertension in survivors, 29 evidence regarding the impact of adapted lifestyle changes on hypertension primarily comes from trials targeting weight loss. Yet, survivors following a 1-year personalized physical activity program did not observe improvement in their blood pressure despite a decrease in total body fat proportion.…”

High incidence of metabolic diseases and sedentary lifestyle underline the need for regular counseling in LTFU for CCS- results from a monocentric prospective study

“…In this study, almost all CCS (97%) consider lifestyle counseling useful as part of care. It is important to inform CCS about their increased risk of developing metabolic diseases such as dyslipidemia, hypertension, diabetes mellitus or obesity (8,11). A healthy lifestyle including regular physical activity and nutrient and vitamin rich diet can reduce this risk (36).…”

“…Consequently, multiple studies evaluated the effect of counseling on the CCS lifestyle and could demonstrate a reduction in co-morbidities as well as a better quality of life due to a healthy lifestyle (9,10). Furthermore, CCS improved in blood pressure due to lifestyle counseling in previous studies (11). Therefore, a healthier lifestyle could result in less co-morbidities including the metabolic syndrome among CCS (9).…”