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Long-term Follow-up of Cardiovascular Risk Factors in Patients Given Chemotherapy for Disseminated Nonseminomatous Testicular Cancer

Jourik A. Gietema, MD; Dirk Th. Sleijfer, MD; Pax H. B. Willemse, MD; Heimen Schraffordt Koops, MD; Engbertha van Ittersum, MD; W. M. Monique Verschuren, MSc; Daan Kromhout, PhD; Willem J. Sluiter, PhD; Nanno H. Mulder, MD; and Elisabeth G. E. de Vries, MD
[+] Article, Author, and Disclosure Information

Requests for Reprints: Elisabeth G.E. de Vries, MD, Division of Medical Oncology, Department of Internal Medicine, University Hospital, Oostersingel 59, 9713 EZ Groningen, The Netherlands.

Current Author Addresses: Drs. de Vries, Gietema, Sleijfer, Willemse, Ittersum, and Mulder: Division of Medical Oncology, Department of Internal Medicine, University Hospital, Oostersingel 59, 9713 EZ Groningen, The Netherlands.

Dr. Schraffordt Koops: Department of Surgical Oncology, University Hospital, Oostersingel 59, 9713 EZ Groningen, The Netherlands.

Dr. Sluiter: Department of Endocrinology, University Hospital, Oostersingel 59, 9713 EZ Groningen, The Netherlands.

Ms. Verschuren and Dr. Kromhout: National Institute of Public Health and Environmental Protection, P.O. Box 1, 3720 BA Bilthoven, The Netherlands.

© 1992 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1992;116(9):709-715. doi:10.7326/0003-4819-116-9-709
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Objective: To assess cardiovascular risk factors over time in patients who received chemotherapy for disseminated testicular cancer and were apparently cured.

Design: Cohort study.

Setting: Referral center.

Patients: Fifty-seven consecutive patients (median age, 28 years; range, 16 to 43 years) who received cisplatin-containing chemotherapy between 1978 and 1985.

Measurements: Serum cholesterol and high-density lipoprotein (HDL) levels, body mass index (BMI), blood pressure, kidney function, and hormonal status were monitored during follow-up after chemotherapy (median follow-up, 88 months; range, 56 to 143 months). The BMI and cholesterol values obtained 4 to 6 years after chemotherapy were compared with values from a sample of healthy, age-matched Dutch men; the cholesterol level was also compared with that of 31 patients treated with orchidectomy for stage I disease.

Results:The mean cholesterol level in patients at the start of chemotherapy was 3.96 ± 0.98 mmol/L [153 ± 38 mg/dL], increasing 4 to 6 years later to 6.12 ± 1.20 mmol/L [237 ± 46 mg/dL] (P < 0.001); 49 of 57 patients had an elevated low-density lipoprotein (LDL) cholesterol level (> 3.4 mmol/L [130 mg/dL]), with a mean level of 4.47 ± 1.05 mmol/L [173 ± 41 mg/dL]. Compared with a sample of healthy Dutch men, the chemotheraphy group had an elevated cholesterol level (P < 0.05). At 4 to 6 years, the mean HDL cholesterol level was 0.76 ± 0.18 mmol/L [29 ± 7 mg/dL], which was low compared with that of the healthy Dutch men (P < 0.05). The mean BMI for all patients was 2.8% higher than expected 4 to 6 years after chemotherapy (P< 0.01) but was not higher than expected 7 to 10 years after chemotherapy.

Conclusions: In addition to other known late side effects of chemotherapy in patients with testicular cancer, hypexrcholesterolemia and overweight might represent risk factors for cardiovascular disease in such patients, especially in those who are younger.





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