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5. Dyslipidemia and Cardiovascular Disease Among Childhood Cancer Survivors: A St. Jude Lifetime Cohort Report

Author

Goldberg, Jason F, primary, Hyun, Geehong, additional, Ness, Kirsten K, additional, Dixon, Stephanie B, additional, Towbin, Jeffrey A, additional, Rhea, Isaac B, additional, Ehrhardt, Matthew J, additional, Srivastava, Deo Kumar, additional, Mulrooney, Daniel A, additional, Hudson, Melissa M, additional, Robison, Leslie L, additional, Jefferies, John L, additional, Rohatgi, Anand, additional, and Armstrong, Gregory T, additional

Published
2023
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7. Dyslipidemia and cardiovascular disease among childhood cancer survivors: a St. Jude Lifetime Cohort report.

Author

Goldberg, Jason F, Hyun, Geehong, Ness, Kirsten K, Dixon, Stephanie B, Towbin, Jeffrey A, Rhea, Isaac B, Ehrhardt, Matthew J, Srivastava, Deo Kumar, Mulrooney, Daniel A, Hudson, Melissa M, Robison, Leslie L, Jefferies, John L, Rohatgi, Anand, and Armstrong, Gregory T

Subjects
*DYSLIPIDEMIA, *CHILDHOOD cancer, *CARDIOVASCULAR diseases, *HDL cholesterol, *CANCER survivors, *JUVENILE diseases
Abstract

Background Childhood cancer survivors have increased risk of dyslipidemia and atherosclerotic cardiovascular disease (CVD). The aim of this study was to evaluate the prevalence and associated cardiovascular risks of specific lipid abnormalities among childhood cancer survivors. Methods Comprehensive lipid panel measurements were obtained from 4115 5-year survivors, with 3406 (mean age at evaluation = 35.2 years, SD = 10.4 years) not having previous dyslipidemia diagnosis, as well as 624 age, sex, and race and ethnicity matched community controls. Results Previously undiagnosed dyslipidemia with abnormal low-density lipoprotein (LDL) cholesterol (>160 mg/dL), non–high density lipoprotein (HDL) cholesterol (>190 mg/dL), HDL cholesterol (<40 mg/dL for men, <50 mg/dL for women), and triglycerides (>150 mg/dL) were identified in 4%, 6%, 30%, and 17%, respectively. Survivors without previous dyslipidemia diagnosis had higher LDL cholesterol and non-HDL cholesterol and lower HDL cholesterol than community controls. Cranial radiotherapy (relative risk [RR] = 2.2, 95% confidence interval [CI] = 1.6 to 3.0 for non-HDL cholesterol) and total body irradiation for hematopoietic cell transplantation (RR = 6.7, 95% CI = 3.5 to 13.0 for non-HDL cholesterol; RR = 9.9, 95% CI = 6.0 to 16.3 for triglycerides) were associated with greater risk of dyslipidemia. Diagnoses of low HDL cholesterol (hazard ratio [HR] = 2.9, 95% CI = 1.8 to 4.7) and elevated triglycerides (HR = 3.1, 95% CI = 1.9 to 5.1) were associated with increased risk for myocardial infarction, and diagnoses of high LDL cholesterol (HR = 2.2, 95% CI = 1.3 to 3.7), high non-HDL cholesterol (HR = 2.2, 95% CI = 1.3 to 3.7), low HDL cholesterol (HR = 3.9, 95% CI = 2.8 to 5.4), and elevated triglycerides (HR = 3.8, 95% CI = 2.7 to 5.5) were associated with increased risk for cardiomyopathy. Conclusions Previously undiagnosed dyslipidemia among childhood cancer survivors was associated with increased risk for myocardial infarction and cardiomyopathy. Comprehensive dyslipidemia evaluation and treatment are needed to reduce cardiovascular morbidity in this population. [ABSTRACT FROM AUTHOR]

Published
2024
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11. Pediatric Cardio-Oncology Medicine: A New Approach in Cardiovascular Care

Author

Martinez, Hugo R., primary, Beasley, Gary S., additional, Goldberg, Jason F., additional, Absi, Mohammed, additional, Ryan, Kaitlin A., additional, Guerrier, Karine, additional, Joshi, Vijaya M., additional, Johnson, Jason N., additional, Morin, Cara E., additional, Hurley, Caitlin, additional, Morrison, Ronald Ray, additional, Rai, Parul, additional, Hankins, Jane S., additional, Bishop, Michael W., additional, Triplett, Brandon M., additional, Ehrhardt, Matthew J., additional, Pui, Ching-Hon, additional, Inaba, Hiroto, additional, and Towbin, Jeffrey A., additional

Published
2021
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12. Cardiac remodeling after anthracycline and radiotherapy exposure in adult survivors of childhood cancer: A report from the St Jude Lifetime Cohort Study

Author

Jefferies, John L., primary, Mazur, Wojciech M., additional, Howell, Carrie R., additional, Plana, Juan C., additional, Ness, Kirsten K., additional, Li, Zhenghong, additional, Joshi, Vijaya M., additional, Green, Daniel M., additional, Mulrooney, Daniel A., additional, Towbin, Jeffrey A., additional, Martinez, Hugo R., additional, Goldberg, Jason F., additional, Howell, Rebecca M., additional, Srivastava, Deo Kumar, additional, Robison, Leslie L., additional, Hudson, Melissa M., additional, and Armstrong, Gregory T., additional

Published
2021
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14. Association of persistent tachycardia with early myocardial dysfunction in children undergoing allogeneic hematopoietic cell transplantation

Author

Goldberg, Jason F., primary, Peters, Emily J., additional, Tolley, Elizabeth A., additional, Hagler, Mazal N., additional, Joshi, Vijaya M., additional, Wallace, Shelby E., additional, Nouer, Simonne S., additional, Beasley, Gary S., additional, Martinez, Hugo R., additional, Ryan, Kaitlin A., additional, Absi, Mohammed A., additional, Strelsin, Jenny R., additional, Towbin, Jeffrey A., additional, and Triplett, Brandon M., additional

Published
2021
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16. Cardiovascular Family History Increases Risk for Late-Onset Adverse Cardiovascular Outcomes in Childhood Cancer Survivors: A St. Jude Lifetime Cohort Report

Author

Goldberg, Jason F., primary, Ness, Kirsten K., additional, Chi, Xiaofei, additional, Santucci, Aimee K., additional, Plana, Juan Carlos, additional, Joshi, Vijaya M., additional, Luepker, Russell V., additional, Durand, Jean-Bernard, additional, Partin, Robyn E., additional, Howell, Rebecca M., additional, Wilson, Carmen L., additional, Towbin, Jeffrey A., additional, Jefferies, John L., additional, Srivastava, Deo Kumar, additional, Hudson, Melissa M., additional, Robison, Leslie L., additional, and Armstrong, Gregory T., additional

Published
2021
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19. Novel use of cangrelor in pediatrics: A pilot cohort study demonstrating use in ventricular assist devices.

Author

Fahnhorst, Sarah E., Beasley, Gary, Goldberg, Jason F., Martinez, Hugo R., Ryan, Kaitlin A., Towbin, Jeffrey A., Boston, Umar, and Absi, Mohammed

Subjects
HEART assist devices, MECHANICAL hearts, CHILD patients, CONGENITAL heart disease, PERCUTANEOUS coronary intervention, PLATELET function tests, COHORT analysis
Abstract

Thromboembolic events and bleeding are major sources of morbidity among pediatric patients supported on a ventricular assist device (VAD). Pharmacokinetics and pharmacodynamics of enteral antiplatelet agents are affected and variable due to erratic enteral absorption in end‐stage heart failure and VAD circulation. Additionally, 20%‐40% of the population are poor metabolizers of clopidogrel, a prodrug, making cangrelor an alternative when antiplatelet therapy is crucial. Cangrelor has been used effectively and safely for short durations in adults during percutaneous coronary interventions, but the use of cangrelor is still under investigation in pediatrics. This case series utilized cangrelor, a novel short‐acting, reversible, intravenous P2Y12 platelet inhibitor in managing pediatric patients supported with a VAD. We performed a retrospective, single‐center review of patients admitted to a tertiary medical center with end‐stage heart failure requiring mechanical circulatory support and concomitant cangrelor administration between January 2019 and March 2020. Platelet function testing, cangrelor dose, bleeding complications, thromboembolic events, and frequency of circuit interventions during the use of cangrelor were recorded. Optimal platelet reactivity, defined as P2Y12 < 180 platelet reaction units (PRU), was measured with serial point‐of‐care testing (VerifyNow). Seven patients, median age of 4.9 years, met the above criteria. Three patients had a diagnosis of complex congenital heart disease. Four patients had dilated or restrictive cardiomyopathy. All patients were on continuous flow VADs. The median VAD duration was 84.5 days (IQR 61.5‐103). The median duration on cangrelor was 43 days (IQR 8‐70). The median cangrelor dose to reach the therapeutic threshold was 0.75 μg/kg/min with the mean P2Y12, while on cangrelor of 164.75 PRU. Bleeding complications included mild gastrointestinal bleeding and hematuria. There was one patient with pump thrombosis requiring intervention. There were no cerebrovascular events while on cangrelor. We report the first successful long‐term use of cangrelor in pediatric patients. The reversibility and short half‐life of cangrelor make it a feasible antiplatelet agent in selected patients. This data supports the use of cangrelor in children as a viable antiplatelet option; with minimal bleeding complications and no cerebrovascular events demonstrated in this cohort. [ABSTRACT FROM AUTHOR]

Published
2021
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