# Cardiovascular Risk Factors Among Younger and Older C-AYA Cancer Survivors Treated with Anthracyclines: A Single-Center Analysis

## TL;DR

Young cancer survivors treated with anthracyclines show high rates of heart disease risk factors like high cholesterol and high blood pressure, but are less likely to get treatment.

## Contribution

This study is the first to analyze cardiovascular risk factors in C-AYA cancer survivors under 20 years old treated with anthracyclines.

## Key findings

- 51.7% of C-AYAs under 20 had dyslipidemia and 31.9% had hypertension.
- Younger survivors were less likely to receive lipid-lowering or antihypertensive therapy compared to older survivors.
- Dyslipidemia was underdiagnosed in younger C-AYAs, with only 12.6% having an ICD code for it.

## Abstract

Survivors of childhood, adolescent, and young adult-onset cancer (C-AYAs) represent a growing population at an increased risk for cardiovascular disease and mortality. Cardiovascular disease risk factors (CVRFs) increase this risk for cardiovascular disease in a synergistic fashion among survivors treated with anthracyclines. However, the data characterizing the prevalence of CVRFs—particularly among C-AYAs under 20 years of age—remains limited. In a cohort of C-AYAs treated with anthracyclines, we observed a high prevalence of dyslipidemia (51.7%) and hypertension (31.9%) among those less than 20 years old, indicating an early onset of CVRFs. Despite these findings, the prescription data demonstrated that younger C-AYAs were less likely than their older peers to be treated with lipid-lowering and antihypertensive therapy. These findings underscore the need for the proactive screening and management of CVRFs, beginning at an early age.

Background/Objectives: Among survivors of cancer diagnosed in childhood, adolescence, or young adulthood (C-AYAs), cardiotoxic therapies combined with acquired cardiovascular risk factors (CVRFs) increase the risk for cardiovascular events. To our knowledge, no prior analysis has examined CVRFs among C-AYAs < 20 years old or compared CVRFs among younger and older C-AYAs. Methods: In this single-center study, individuals diagnosed with cancer at ≤39 years, treated with anthracycline-based chemotherapy (2010–2023), and with a post-treatment lipid panel and ≥2 post-treatment ambulatory blood pressure measurements were included. The CVRF prevalence was assessed among C-AYAs < 20 and ≥20 years old, using age-appropriate AAP and ACC/AHA guidelines. These prevalences were compared with the ICD-9/10 code prevalence. The prescription of medications with antihypertensive effects (MAHEs) and lipid-lowering therapy was assessed. Results: Among 276 C-AYAs, the median age was 28.1 years (IQR 18.1–38.3) at dyslipidemia screening and 29.3 (IQR 20.0–38.7) at hypertension screening. Dyslipidemia was present in 52.9% (146/276) and hypertension in 56.2% (155/276) of C-AYAs. C-AYAs < 20 years old had a high prevalence of dyslipidemia, 51.7% (45/87), and hypertension, 31.9% (29/91). CVRFs were frequently underdiagnosed, particularly dyslipidemia, among C-AYAs < 20 years old, with only 12.6% (11/87) having a diagnosis via the ICD code. C-AYAs < 20 years old with diagnoses of dyslipidemia and hypertension were significantly less likely to receive lipid-lowering therapy (2.2% vs. 14.9%) and trended toward less MAHEs (13.8% vs. 31.0%) compared to C-AYAs ≥ 20. Conclusions: Among C-AYAs treated with anthracyclines, dyslipidemia and hypertension were highly prevalent even at a young age (<20 years). Younger survivors with dyslipidemia and hypertension were less frequently prescribed lipid-lowering therapy or MAHEs.