Arterial elasticity as a risk factor for early cardiovascular disease among testicular cancer survivors treated with platinum-based chemotherapy: a cross-sectional pilot study
Authors Blaes AH, Mulrooney DA, Vogel RI, Solovey A, Hebbel R, Peterson BA, Neglia JP, Biewen C, Konety SH, Duprez DA
Received 16 September 2017
Accepted for publication 16 February 2018
Published 10 September 2018 Volume 2018:14 Pages 205—211
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Dr Pietro Scicchitano
Anne H Blaes,1 Daniel A Mulrooney,2 Rachel Isaksson Vogel,3 Anna Solovey,1 Robert Hebbel,1 Bruce A Peterson,1 Joseph P Neglia,4 Carter Biewen,5 Suma H Konety,6 Daniel A Duprez6
1Division of Hematology/Oncology, University of Minnesota, Minneapolis, MN, USA; 2St Jude Children’s Research Hospital, Memphis, TN, USA; 3Division of Gynecology/Oncology, University of Minnesota, MN, USA; 4Department of Pediatrics, University of Minnesota, MN, USA; 5Division of Pediatrics, University of California San Francisco, CA, USA; 6Division of Cardiology, University of Minnesota, MN, USA
Purpose: Testicular cancer survivors who have received platinum-based chemotherapy are at risk for premature cardiovascular disease. The etiology of this risk is not well understood. This pilot study explores the impact of platinum-based chemotherapy on endothelial function.
Methods: Testicular cancer survivors <30 years old at the time of diagnosis who received platinum-based chemotherapy between 2002 and 2012, as well as 17 similarly aged male controls, were identified. Consented subjects underwent vascular assessment using the HDI/PulseWave CR-2000 Cardiovascular Profiling System and the Endo-PAT2000 system. Biomarkers and functional test markers were compared among cases, controls, and a group of historical controls using two sided two-sampled t-tests and Wilcoxon rank-sum tests.
Results: Thirteen survivors with a median age of 30.2 years and body mass index of 27.3 were enrolled, along with 17 healthy controls with a median age of 27.1 years and body mass index of 24.8. Median time from chemotherapy was 4.7 (range: 0.8–14) years. There was no statistical difference in reactive hyperemia peripheral arterial tonometry ratio between cases and controls (p = 0.574). There was no statistical difference in small or large artery elasticity between cases and controls (p = 0.086) or between cases and historical controls (p = 0.729). There was also no statistical difference in the blood levels of circulating endothelial cells, von Willebrand factor, and vascular cell adhesion molecules. There was a trend toward increased metabolic syndrome in cases (15%) as compared to recruited controls (6%), though this difference was not statistically significant (p = 0.565).
Conclusion: Testicular cancer survivors have no clinically significant difference in endothelial function compared to controls 4 years after the completion of chemotherapy. Further research is needed to explore the secondary modifiable causes that may contribute to the risk of premature cardiovascular disease.
Keywords: vascular injury, testicular cancer, chemotherapy, cardio-oncology, cardiac injury, cardiac disease
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