Metabolic syndrome and cardiovascular risk among long-term survivors of acute lymphoblastic leukaemia - From the St. Jude Lifetime Cohort

Adult survivors of childhood acute lymphoblastic leukaemia (ALL) have a four-fold excess risk of mortality from cardiovascular disease. This cardiovascular risk has not been fully characterized. ALL survivors [n=784, median age 31 center dot 7years (18 center dot 9-59 center dot 1)] in the St. Jude Lifetime Cohort Study underwent evaluation for cardiovascular risk and metabolic syndrome (MetS) according to National Cholesterol Education Program - Adult Treatment Panel III criteria. Comparisons were made to 777 age-, sex-, and race-matched controls from the National Health and Nutrition Examination Survey (NHANES). MetS was identified in 259 survivors (33 center dot 6%) and associated with older age in 5-year increments (relative risk [RR] 1 center dot 13, 95% confidence interval [CI] 1 center dot 06-1 center dot 19) and prior cranial radiotherapy (CRT) (with craniospinal radiation: RR 1 center dot 88, 95%CI 1 center dot 32-2 center dot 67; without: RR 1 center dot 67, 95%CI 1 center dot 26-2 center dot 23). Measures of obesity were highly prevalent among female survivors and CRT recipients. Compared to NHANES controls, ALL survivors had a higher risk of MetS (RR 1 center dot 43, 95%CI 1 center dot 22-1 center dot 69), hypertension (RR 2 center dot 43, 95%CI 2 center dot 06-2 center dot 86), low high-density lipoprotein (RR 1 center dot 40, 95%CI 1 center dot 23-1 center dot 59), obesity (RR 1 center dot 47, 95%CI 1 center dot 29-1 center dot 68) and insulin resistance (1 center dot 64, 95%CI 1 center dot 44-1 center dot 86). This large study of clinically evaluated ALL survivors identified a high prevalence of MetS, obesity and cardiovascular risk, particularly in CRT recipients, underscoring the need for screening and aggressive reduction of modifiable risks.