Diabetes, hypertension, and cardiovascular events in survivors of hematopoietic cell transplantation: a report from the bone marrow transplantation survivor study
K. Scott Baker1, Kirsten K. Ness1, Julia Steinberger1, Andrea Carter2, Liton Francisco2, Linda J. Burns1, Charles Sklar3, Stephen Forman4, Daniel Weisdorf1, James G. Gurney5, and Smita Bhatia2,4
1 Departments of Pediatrics and Medicine, University of Minnesota, Minneapolis; 2 Division of Populations Sciences, City of Hope National Medical Center, Duarte, CA; 3 Memorial Sloan-Kettering Cancer Center, Department of Pediatrics, New York, NY; 4 Division of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA; and 5 Department of Pediatrics, University of Michigan, Ann Arbor
We ascertained the prevalence of self-reported late occurrence of diabetes, hypertension, and cardiovascular (CV) disease in 1089 hematopoietic cell transplantation (HCT) survivors who underwent HCT between 1974 and 1998, survived at least 2 years, and were not currently taking immunosuppressant agents and compared them with 383 sibling controls. All subjects completed a 255-item health questionnaire. The mean age at survey completion was 39.3 years for survivors and 38.6 years for siblings; mean follow-up was 8.6 years. Adjusting for age, sex, race, and body mass index (BMI), survivors of allogeneic HCT were 3.65 times (95% confidence interval [CI], 1.82-7.32) more likely to report diabetes than siblings and 2.06 times (95% CI, 1.39-3.04) more likely to report hypertension compared with siblings but did not report other CV outcomes with any greater frequency. Recipients of autologous HCTs were no more likely than siblings to report any of the outcomes studied. Allogeneic HCT survivors were also more likely to develop hypertension (odds ratio [OR] = 2.31; 95% CI, 1.45-3.67) than autologous recipients. Total body irradiation (TBI) exposure was associated with an increased risk of diabetes (OR = 3.42; 95% CI, 1.55-7.52). Thus, HCT survivors have a higher age- and BMI-adjusted risk of diabetes and hypertension, potentially leading to a higher than expected risk of CV events with age.
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