# Definition, Prevalence and Management of Dyslipidemia in Patients and Survivors of Childhood and Adolescent Cancer—A Systematic Review

## TL;DR

This review examines how dyslipidemia is defined, how common it is, and how it's managed in childhood and adolescent cancer patients and survivors, highlighting inconsistencies in definitions and the need for standardized approaches.

## Contribution

The study provides a systematic review of definitions, prevalence, and management of dyslipidemia in childhood and adolescent cancer survivors, revealing significant heterogeneity in current practices.

## Key findings

- Definitions and cutoffs for dyslipidemia in childhood cancer survivors vary widely across studies.
- The prevalence of high triglycerides ranged from 0% to 75% depending on the cutoff used.
- Lifestyle modifications were the only reported preventive strategy for dyslipidemia in this population.

## Abstract

Dyslipidemia is a relevant risk factor for premature cardiovascular disease, which contributes to long-term complications such as atherosclerosis, heart attack, or stroke. We know that patients and survivors of childhood cancer have an increased risk of cardiovascular disease due to the oncological treatment they have received. However, the definition of dyslipidemia is very heterogeneous in this population, which influences reporting of the prevalence of abnormal lipid values and its management. In this systematic review, we included 53 studies to provide an overview of the currently used definitions and cutoffs for dyslipidemia or abnormal lipid values and its prevalence in patients and survivors of childhood and adolescent cancer. This review further describes different approaches to treat and prevent dyslipidemia in this population.

Background/Objectives: There is little information on the definition and management of dyslipidemia in patients and survivors of childhood, adolescent and young adult (CAYA) cancer. However, it is known that this population is at higher risk of developing cardiovascular disease (CVD). Dyslipidemia, hypertension, and metabolic syndrome are common among CAYA cancer survivors due to the cancer itself or the treatment received. Therefore, managing dyslipidemia in this population is crucial to mitigate the risk of long-term CVD. The aim of this systematic review was to summarize currently used definitions and cutoffs for dyslipidemia, its prevalence, and management strategies in CAYA cancer survivors. This review further describes reported pharmacological and lifestyle interventions and their impact on lipid levels. Methods: We conducted a systematic literature search in PubMed, including studies published in English, German or French between January 2015 and February 2025. The population included individuals diagnosed with any type of CAYA cancer prior to 25 years of age and either receiving cancer treatment or in follow-up care. We considered all types of publications except for Phase I and II studies. We followed PRISMA guidelines, assessed the quality of the eligible studies according to the respective Joanna Briggs Institute’s Critical Appraisal Tools, and reported the results descriptively. Results: Of 575 identified publications, 53 fulfilled the inclusion criteria. Forty-three studies reported on the definitions of abnormal lipid values, 40 stated the prevalence of abnormal lipid values, and 17 studies described management approaches, of which 12 were case reports and small case series. For all three outcomes, the results were very heterogeneous. Using the example of triglycerides (TGs), the cutoff values for high TGs ranged from 5.17 mmol/L to 6.2 mmol/L and the reported prevalence of high TGs ranged from 0% to 75%, with an average of 31%. The only reported intervention to prevent dyslipidemia in CAYA cancer survivors was lifestyle modification. Preventive strategies that started during treatment were lifestyle modifications and fish oil supplements. Conclusions: Our systematic review provides a comprehensive overview of existing definitions, prevalences, and management of abnormal lipid values in CAYA cancer patients and survivors. However, the identified heterogeneities indicate that reported prevalences and results of interventions must be interpreted cautiously. An internationally harmonized approach to defining and reporting lipid values in CAYA cancer survivors is urgently needed to enable tailored screening and treatment strategies.