Cardiovascular Risk and Insulin Resistance in Childhood Cancer Survivors

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• 作者：Julia Steinberger ; MD ; MS¹ ; ^{stein055@umn.edu} ; Alan R. Sinaiko ; MD¹ ; ⁴ ; Aaron S. Kelly ; PhD¹ ; Wendy M. Leisenring ; ScD² ; ³ ; Lyn M. Steffen ; PhD ; MPH³ ; ⁴ ; Pamela Goodman ; MS³ ; Daniel A. Mulrooney ; MD ; MS¹ ; Andrew C. Dietz ; MD¹ ; Antoinette Moran ; MD¹ ; Joanna L. Perkins ; MD ; MS⁵ ; K. Scott Baker ; MD ; MS²
• 关键词：BMI ; Body mass index ; CCS ; Childhood cancer survivors ; CNS ; Central nervous system ; CV ; Cardiovascular ; DXA ; Dual-energy X-ray absorptiometry ; HDL ; High-density lipoprotein ; HOMA-IR ; Homeostasis model assessment-insulin resistance ; LBM ; Lean body mass ; LD
• 刊名：The Journal of Pediatrics
• 出版年：2012
• 出版时间：March, 2012
• 年：2012
• 卷：160
• 期：3
• 页码：494-499
• 全文大小：161 K

文摘

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Objective

Increased cardiovascular (CV) risk has been reported in adults who are childhood cancer survivors (CCS). We sought to determine the emergence of CV risk factors in CCS while still children.

Study design

CCS in remission ¡Ý5 years from cancer diagnosis (n = 319, age = 14.5 years) and their siblings (control subjects, n = 208, age = 13.6 years) participated in this cross-sectional study of CV risk, which included physiologic assessment of insulin sensitivity/resistance (hyperinsulinemic euglycemic clamp). Adjusted comparisons between CCS major diagnoses (leukemia [n = 110], central nervous system tumors [n = 82], solid tumors [n = 127]) and control subjects were performed with linear regression for CV risk factors and insulin sensitivity.

Results

Despite no significant differences in weight and body mass index, CCS had greater adiposity (waist [73.1 versus 71.1 cm, P = .02]; percent fat [28.1 versus 25.9 % , P = .007]), lower lean body mass (38.4 versus 39.9 kg, P = .01) than control subjects. After adjustment for adiposity, CCS had higher total cholesterol level (154.7 versus148.3 mg/dL, P = .004), low-density lipoprotein cholesterol level (89.4 versus 83.7 mg/dL, P = .002), and triglyceride level (91.8 versus 84 mg/dL, P = .03) and were less insulin sensitive (insulin stimulated glucose uptake, measure of insulin resistance, adjusted for lean body mass 12.1 versus 13.4 mg/kg/min, P = .002) than control subjects.

Conclusions

CCS have greater CV risk than healthy children. Because CV risk factors track from childhood to adulthood, early development of altered body composition and decreased insulin sensitivity in CCS may contribute significantly to their risk of early CV morbidity and mortality.