Prevalence of untreated and uncontrolled cardiovascular risk factors in survivors of allogeneic cell transplantation


Cardiovascular risk factors (CVRF) are frequent among long-term survivors after allogeneic hematopoietic cell transplantation (HCT) but prospective data on CVRF are sparse. We conducted a cross-sectional single center study including patients who underwent a first HCT mostly for hematologic malignancies at our center between 2000 and 2016, surviving at least 1 year. 260 patients (median age 54 years [range 19–78], 40% female) who were median 6 years (range 1–16) after transplantation were included. Most patients (232, 89%) had peripheral blood stem cell transplantation. cGVHD was present in 41% at the time of study inclusion. Prevalence of hypertension, dyslipidemia, and diabetes was 58%, 63% and 9%, respectively. Untreated hypertension, dyslipidemia and diabetes was found in 15%, 35% and 2%. Among patients with treated hypertension, 38% did not have blood pressure controlled to levels ≤140/90 mmHg. 36% patients under lipid-lowering therapy did not reach their LDL target. Multivariable logistic regression analyses showed that age and diabetes increased the likelihood for hypertension and dyslipidemia, whereas body mass index, cGVHD and male sex predicted hypertension only. In summary, CVRF in long-term survivors are frequent and persisting after cessation of immunosuppression. A large proportion of CVRF are either untreated or uncontrolled.

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  1. 1.

    Gratwohl A, Pasquini MC, Aljurf M, Atsuta Y, Baldomero H, Foeken L, et al. One million haematopoietic stem-cell transplants: a retrospective observational study. Lancet Haematol. 2015;2:e91–100.

    Article  Google Scholar 

  2. 2.

    Syrjala KL, Martin PJ, Lee SJ. Delivering care to long-term adult survivors of hematopoietic cell transplantation. J Clin Oncol. 2012;30:3746–51.

    Article  Google Scholar 

  3. 3.

    Chow EJ, Mueller BA, Baker KS, Cushing-Haugen KL, Flowers ME, Martin PJ, et al. Cardiovascular hospitalizations and mortality among recipients of hematopoietic stem cell transplantation. Ann Intern Med. 2011;155:21–32.

    Article  Google Scholar 

  4. 4.

    Chow EJ, Baker KS, Lee SJ, Flowers ME, Cushing-Haugen KL, Inamoto Y, et al. Influence of conventional cardiovascular risk factors and lifestyle characteristics on cardiovascular disease after hematopoietic cell transplantation. J Clin Oncol. 2014;32:191–8.

    Article  Google Scholar 

  5. 5.

    Tichelli A, Bucher C, Rovó A, Stussi G, Stern M, Paulussen M, et al. Premature cardiovascular disease after allogeneic hematopoietic stem-cell transplantation. Blood. 2007;110:3463–71.

    CAS  Article  Google Scholar 

  6. 6.

    Williams B, Mancia G, Spiering W, Rosei EA, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39:3021–3104.

    Article  Google Scholar 

  7. 7.

    Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice. Eur Heart J. 2016;37:2315–81.

    Article  Google Scholar 

  8. 8.

    Fukuyama N, Homma K, Wakana N, Kudo K, Suyama A, Ohazama H, et al. Validation of the Friedewald Equation for Evaluation of Plasma LDL-Cholesterol. J Clin Biochem Nutr. 2008;43:1–5.

    CAS  Article  Google Scholar 

  9. 9.

    Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2018. Diabetes Care. 2018; 41 Suppl 1: 313–327.

  10. 10.

    Jagasia MH, Greinix HT, Arora M, Williams KM, Wolff D, Coewen EW, et al. National Institutes of Health consensus development project on criteria for clinical trials in chronic graft-versus-host disease: I. The 2014 Diagnosis and Staging Working Group report. Biol Blood Marrow Transplant. 2015;21:389–401.

    Article  Google Scholar 

  11. 11.

    Majhail NS, Challa TR, Mulrooney DA, Baker KS, Burns LJ. Hypertension and diabetes mellitus in adult and pediatric survivors of allogeneic hematopoietic cell transplantation. Biol Blood Marrow Transplant. 2009;15:1100–7.

    CAS  Article  Google Scholar 

  12. 12.

    Tichelli A, Passweg J, Wójcik D, Rovó A, Harousseau JL, Masszi T, et al. Late cardiovascular events after allogeneic hematopoietic stem cell transplantation: a retrospective multicenter study of the Late Effects Working Party of the European Group for Blood and Marrow Transplantation. Haematologica. 2008;93:1203–10.

    Article  Google Scholar 

  13. 13.

    Armenian SH, Sun CL, Vase T, Ness KK, Blum E, Francisco L, et al. Cardiovascular risk factors in hematopoietic cell transplantation survivors: role in development of subsequent cardiovascular disease. Blood. 2012;120:4505–12.

    CAS  Article  Google Scholar 

  14. 14.

    Baker KS, Ness KK, Steinberger J, Carter A, Francisco L, Burns LJ, et al. Diabetes, hypertension, and cardiovascular events in survivors of hematopoietic cell transplantation: a report from the bone marrow transplantation survivor study. Blood. 2007;109:1765–72.

    CAS  Article  Google Scholar 

  15. 15.

    Majhail NS, Flowers ME, Ness KK, Jagasia M, Carpenter PA, Arora M, et al. High prevalence of metabolic syndrome after allogeneic hematopoietic cell transplantation. Bone Marrow Transplant. 2009;43:49–54.

    CAS  Article  Google Scholar 

  16. 16.

    Premstaller M, Perren M, Kocack K, Arranto C, Favre G, Lohri A, et al. Dyslipidemia and lipid-lowering treatment in a hematopoietic stem cell transplant cohort: 25 years of follow-up data. J Clin Lipidol. 2018;12:464–480.

    Article  Google Scholar 

  17. 17.

    Ference BA, Ginsberg H, Graham I, Kausik KR, Packard CJ, Bruckert E, et al. Low-density lipoproteins cause atherosclerotic cardiovascular disease. 1. Evidence from genetic, epidemiologic, and clinical studies. A consensus statement from the European Atherosclerosis Society Consensus Panel. Eur Heart J. 2017;38:2459–2472.

    CAS  Article  Google Scholar 

  18. 18.

    Huang Y, Cai X, Mai W, Li M, Hu Y. Association between prediabetes and risk of cardiovascular disease and all cause mortality: systematic review and meta-analysis. BMJ. 2016;355:i5953.

    Article  Google Scholar 

  19. 19.

    Vistisen D, Kivimäki M, Perreault L, Hulman A, Witte DR, Brunner EJ, et al. Reversion from prediabetes to normoglycaemia and risk of cardiovascular disease and mortality: the Whitehall II cohort study. Diabetologia. 2019;62:1385–90.

    Article  Google Scholar 

  20. 20.

    Oudin C, Auquier P, Bertrand Y, Contet A, Kanold J, Sirvent N, et al. Metabolic syndrome in adults who received hematopoietic stem cell transplantation for acute childhood leukemia: an LEA study. Bone Marrow Transplant. 2015;50:1438–44.

    CAS  Article  Google Scholar 

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Arranto, C.A., Burkard, T., Leuppi-Taegtmeyer, A.B. et al. Prevalence of untreated and uncontrolled cardiovascular risk factors in survivors of allogeneic cell transplantation. Bone Marrow Transplant (2020).

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