Insulin resistance and risk factors for cardiovascular disease in young adult survivors of childhood acute lymphoblastic leukemia

Kevin C. Oeffinger, Beverley Adams-Huet, Ronald G. Victor, Timothy S. Church, Peter G. Snell, Andrea L. Dunn, Debra A. Eshelman-Kent, Robert Ross, Peter M. Janiszewski, Alicia J. Turoff, Sandra Brooks, Gloria Lena Vega

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93 Scopus citations

Abstract

Purpose: To determine the prevalence of insulin resistance and other risk factors for cardiovascular disease (CVD) in young adult survivors of childhood acute lymphoblastic leukemia (ALL). Patients and Methods: In this cross-sectional evaluation of 118 survivors of childhood ALL (median age, 23.0 years; range, 18 to 37 years), insulin resistance was estimated using the homeostasis model for assessment of insulin resistance (HOMA-IR). Sex-specific comparisons were made with a cohort of 30- to 37-year-old individuals from the same region participating in the Dallas Heart Study (DHS, N = 782). ALL survivors were stratified by treatment with and without cranial radiotherapy (CRT). Results: Female ALL survivors had a significantly higher HOMA-IR (CRT, mean 4.6, 95% CI, 3.6 to 5.7; no CRT, mean 3.3, 95% CI, 2.8 to 3.8) in comparison with DHS women (mean 2.4, 95% CI, 2.2 to 2.7). Eighty percent of women treated with CRT had at least three of six CVD risk factors, and they were significantly more likely to have three or more risk factors compared with DHS women (odds ratio [OR], 5.96; 95% CI, 2.15 to 16.47). Male ALL survivors had a significantly higher HOMA-IR (CRT, mean 4.0, 95% CI, 2.8 to 5.6; no CRT, mean 3.4, 95% CI, 2.9 to 3.9) in comparison with DHS men (mean 2.3, 95% CI, 2.1 to 2.6), but were not more likely to have multiple CVD risk factors. Conclusion: ALL survivors had an increased prevalence of insulin resistance in comparison with a cohort of older individuals from the same community. Importantly, women treated with CRT seem to have an increased prevalence of multiple CVD risk factors, warranting close monitoring and risk-reducing strategies.

Original languageEnglish (US)
Pages (from-to)3698-3704
Number of pages7
JournalJournal of Clinical Oncology
Volume27
Issue number22
DOIs
StatePublished - Aug 1 2009

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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    Oeffinger, K. C., Adams-Huet, B., Victor, R. G., Church, T. S., Snell, P. G., Dunn, A. L., Eshelman-Kent, D. A., Ross, R., Janiszewski, P. M., Turoff, A. J., Brooks, S., & Vega, G. L. (2009). Insulin resistance and risk factors for cardiovascular disease in young adult survivors of childhood acute lymphoblastic leukemia. Journal of Clinical Oncology, 27(22), 3698-3704. https://doi.org/10.1200/JCO.2008.19.7251