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Myocardial infarction mortality risk after treatment for Hodgkin disease: a collaborative British cohort study

Anthony J Swerdlow1, Craig D Higgins, Paul Smith

  • 1Section of Epidemiology, Sir Richard Doll Building, Institute of Cancer Research, Sutton, Surrey SM2 5NG, UK. anthony.swerdlow@icr.ac.uk

Journal of the National Cancer Institute
|February 8, 2007
PubMed

Insights

Survivors of Hodgkin disease face a persistently high risk of death from myocardial infarction for at least 25 years post-treatment. Specific chemotherapy drugs like anthracyclines and vincristine, along with radiotherapy, increase this cardiac risk.

Area of Science:

  • Cardiology
  • Oncology
  • Public Health

Background:

  • Hodgkin disease survivors experience increased long-term mortality from myocardial infarction.
  • Limited data exists on the cardiac risks associated with specific Hodgkin disease chemotherapy regimens.

Purpose of the Study:

  • To investigate the long-term risk of myocardial infarction mortality in Hodgkin disease survivors.
  • To identify specific chemotherapy agents and radiotherapy associated with increased cardiac mortality.

Main Methods:

  • A cohort of 7033 Hodgkin disease patients treated in Britain (1967-2000) was followed.
  • Myocardial infarction mortality rates were compared to the general population of England and Wales.

Main Results:

  • A statistically significant excess risk of myocardial infarction mortality was observed (SMR=2.5).
  • Increased risks were linked to supradiaphragmatic radiotherapy, anthracyclines, and vincristine.
  • The doxorubicin, bleomycin, vinblastine, and dacarbazine regimen showed a particularly high risk (SMR=9.5).

Conclusions:

  • The elevated risk of death from myocardial infarction persists for at least 25 years after Hodgkin disease treatment.
  • Supradiaphragmatic radiotherapy, anthracyclines, and vincristine are independently associated with increased cardiac mortality risk.
Abstract

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