Atherosclerotic lesions in lymphoma survivors treated with radiotherapy

Background and purpose: Radiotherapy causes premature atherosclerosis in Hodgkin's lymphoma survivors (HLSs). We determined whether atherosclerosis within the radiation field was predicted by traditional risk factors independent of radiation and compared the extent of atherosclerosis in HLSs treated with mantle field radiotherapy with non-irradiated patients. Material and methods: Forty-three HLSs (median age 50 years, range 38–63) treated with mantle field radiotherapy were included. Cardiovascular risk factors were registered at first follow-up (FU-1) 5–13 years after treatment. A second follow-up (FU-2) occurred 18–27 years after treatment. At FU-2, in-field atherosclerosis was assessed by computed tomography with calculation of coronary artery calcium volume score (CACS) and pre-cranial artery atherosclerosis score (PAS). Peripheral endothelial dysfunction was assessed by ante-brachial strain-gauge plethysmography. CT angiography of pre-cranial vessels was also performed in 43 non-irradiated patients. Results: Multiple linear regression analyses showed that cholesterol at FU-1 was a predictor of CACS (β 308 (95% CI 213–403), p < 0.001), PAS (β 3.67 (95% CI 2.29–5.04), p < 0.001) and peripheral endothelial dysfunction (β 2.74 (95% CI 0.47–5.01), p = 0.02). There were more atherosclerotic lesions in HLSs (n = 141) than in non-irradiated patients (n = 73, p = 0.001). Conclusion: Irradiated arteries are characterized by widespread atherosclerotic lesions aggravated by elevated levels of cholesterol