Vascular Health and Early Atherosclerosis in Childhood Cancer Survivors: Reassuring Findings From Comprehensive Noninvasive Assessment

Background: Coronary artery disease is a major cause of late mortality among childhood cancer survivors (CCS), but the prevalence of early vascular changes remains poorly defined. Objectives: The objective of the study was to evaluate early vascular dysfunction using comprehensive assessment in CCS compared with matched healthy controls. Methods: CCS treated with anthracyclines enrolled in the Preventing Cardiac Sequelae in Pediatric Cancer Survivors study were included. Vascular assessment included carotid intima-media thickness (cIMT), carotid-femoral pulse wave velocity (cfPWV), carotid stiffness index, carotid distensibility, flow-mediated dilation, endothelial peripheral arterial tone test, and echocardiography. CCS were categorized as early (<10 years postdiagnosis) or late (≥10 years). Results: We included 206 CCS (mean age ± SD, 17.4 ± 8.1 years; mean time since diagnosis 12.2 ± 7.7 years) and 150 healthy age-, sex-, body surface area-, and blood pressure-matched controls (19.1 ± 9.7 years). Vascular parameters were not significantly different between CCS and controls, including cfPWV (5.5 ± 0.9 m/s vs 5.6 ± 0.9 m/s, P = 0.940), cIMT (0.046 ± 0.01 cm vs 0.045 ± 0.01 cm, P = 0.790), and carotid distensibility (0.40 ± 0.13 mm/mm Hg vs 0.39 ± 0.14 mm/mm Hg, P = 0.950). Among CCS, male gender was negatively associated with carotid distensibility and flow-mediated dilation, and positively with cfPWV. Late CCS showed higher cfPWV (P < 0.001), higher cIMT (P = 0.035), and lower carotid distensibility (P < 0.001) compared to early CCS; however, these differences did not remain significant compared with matched controls. Conclusions: Vascular markers of early atherosclerosis did not significantly differ between CCS and controls. Late CCS demonstrated mild vascular alteration compared with early CCS, although not compared with the healthy population. Whether these represent subclinical precursors of atherosclerosis needs further study. Routine vascular surveillance in this population is not clearly warranted.