Prediction of Coronary Heart Disease Events in Blood or Marrow Transplantation Recipients.
JACC CardioOncol
; 5(4): 504-517, 2023 Aug.
Article
em En
| MEDLINE
| ID: mdl-37614590
ABSTRACT
Background:
The long-term risk of coronary heart disease (CHD) and clinical models that predict this risk remain understudied in blood or marrow transplantation (BMT) recipients.Objectives:
This study sought to examine the risk of CHD after BMT and identify the associated risk factors.Methods:
Participants included patients transplanted between 1974 and 2014 at City of Hope, University of Minnesota, or University of Alabama at Birmingham and those who survived ≥2 years after BMT. Multivariable logistic regression models assessed CHD risk in BMT survivors compared with a sibling cohort. A self-reported questionnaire and medical records provided information regarding sociodemographics, comorbidities, and therapeutic exposures, which were used to develop a CHD risk prediction nomogram.Results:
Overall, 6,677 BMT recipients participated; the mean age at BMT was 43.9 ± 17.7 years, 58.3% were male, and 73.3% were non-Hispanic Whites. The median length of follow-up was 6.9 years (range 2-46.2 years) from BMT. CHD was reported in 249 participants, with a 20-year cumulative incidence of 5.45% ± 0.39%. BMT survivors had a 1.6-fold greater odds of CHD compared with a sibling cohort (95% CI 1.09-2.40). A nomogram was then developed to predict the risk of CHD at 10 and 20 years after BMT including age at BMT (HR 1.06/y; 95% CI 1.04-1.08), male sex (HR 1.89; 95% CI 1.15-3.11), a history of smoking (HR 1.61; 95% CI 1.01-2.58), diabetes (HR 2.45; 95% CI 1.23-4.89), hypertension (HR 2.02; 95% CI 1.15-3.54), arrhythmia (HR 1.90; 95% CI 0.89-4.06), and pre-BMT chest radiation (yes vs no HR 2.83; 95% CI 1.20-6.67; unknown vs no HR 0.88; 95% CI 0.34-2.28). The C-statistic was 0.77 in the test set (95% CI 0.70-0.83).Conclusions:
This study identified BMT recipients at high risk for CHD, informing targeted screening for early detection and aggressive control of risk factors.
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MEDLINE
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En
Ano de publicação:
2023
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Article