Cardiovascular risk factors, radiation therapy, and myocardial infarction among lymphoma survivors

Figures & data

Table 1. Patient, disease, and treatment characteristics.

Characteristic
Age at diagnosis, median (IQR)	63	(54, 72)
Sex, N (%)
Female	1419	(45)
Male	1732	(55)
Stage, N (%)
I	915	(29)
II	550	(17)
III	656	(21)
IV	967	(31)
Unknown	63	(2.0)
Diabetes, N (%)	148	(4.7)
Hypertension, N (%)	678	(22)
Dyslipidemia, N (%)	362	(11)
≥1 Cardiovascular risk factor, N (%)	1002	(32)
Vascular disease, N (%)	315	(10)
Intrinsic heart disease, N (%)	148	(4.7)
Received anthracyclines, N (%)
Yes	2759	(88)
No	284	(9.0)
Missing	108	(3.4)
Mediastinal RT, N (%)	269	(85)

N = 3151. IQR: interquartile range.

Table 2. Univariable Cox regression results for associations of mediastinal RT and cardiovascular risk factors with MI.

Mediastinal RT	# CV risk factors	HR (95% CI)	p-Value
No	0	1.00
No	≥1	2.99 (1.94–4.62)	<0.001
Yes	0	0.95 (0.34–2.66)	0.9
Yes	≥1	6.70 (3.25–13.82)	<0.001

RT: radiation therapy; CV: cardiovascular; HR: hazard ratio.

Table 3. Cox regression results for associations with MI.

	Univariable		Multivariable
	HR (95% CI)	p-Value	HR (95% CI)	p-Value
Age at diagnosis (years)	1.05 (1.03–1.06)	<0.001	1.05 (1.03–1.06)	<0.001
Female versus male sex	0.67 (0.44–1.01)	0.058	0.58 (0.38–0.89)	0.013
≥1 Cardiovascular risk factor	3.33 (2.22–4.99)	<0.001	2.71 (1.77–4.15)	<0.001
Vascular disease	3.41 (2.12–5.51)	<0.001	1.30 (0.74–2.26)	0.4
Intrinsic heart disease	4.52 (2.51–8.12)	<0.001	2.88 (1.50–5.51)	0.001
Mediastinal RT	1.54 (0.86–2.76)	0.15	1.96 (1.09–3.52)	0.025

Note: RT: radiation therapy; HR: hazard ratio; CI: confidence interval.

Table 4. Predicted absolute 10-year risks of MI.

Mediastinal RT	# CV risk factors	Predicted risk of MI (%)
No	0	2.0
No	≥1	5.3
Yes	0	3.9
Yes	≥1	10.2

RT: radiation therapy; CV: cardiovascular; HR: hazard ratio.

Note. Using hazard ratios from the regression model (Table 3), the absolute 10-year risk of MI is shown for individuals with and without mediastinal RT and CV risk factors, based on the finding that those with neither mediastinal RT and no CV risk factors have a 10-year risk of MI of 2%.

Table

Variable	Diagnosis	Codes
Vascular disease	Myocardial infarction (ICD-8)	410, 410.09, 410.99, 411, 411.09, 411.99
	Myocardial infarction (ICD-10)	I21, I21.0, I21.1, I21.2, I21.3, I21.4, I21.9, I22, I22.0, I22.1, I22.8, I22.9
	Coronary artery disease (ICD-8)	412, 412.09, 412.99, 414, 414.09, 414.99
	Coronary artery disease (ICD-10)	I25, I25.1, I25.2, I25.3, I25.4, I25.6, I25.8
	Angina (ICD-8)	413, 413.09, 413.99
	Angina (ICD-10)	I20, I20.0, I20.1, I20.8, I20.9, I24, I24.0, I24.8, I24.9
	Cardiac arrest (ICD-10)	I46, I46.0, I46.1, I46.9
	Stroke (ICD-8)	430, 430.08, 430.09, 431, 431.08, 431.09, 433, 433.09, 433.99, 434, 434.09, 434.99, 436.01, 436.9
	Stroke (ICD-10)	G46, G46.0, G46.1, G46.2, G46.3, G46.4, G46.5, G46.6, G46.7, G46.8, I60.0, I60.1, I60.2, I60.3, I60.4, I60.5, I60.6, I60.7, I60.8, I60.9, I61, I61.0, I61.1, I61.2, I61.3, I61.4, I61.5, I61.6, I61.8, I61.9, I63, I63.0, I63.1, I63.2, I63.3, I63.4, I63.5, I63.6, I63.8, I63.9, I64
	Carotid artery disease (ICD-8)	432, 432.01, 432.02, 432.08, 432.09, 432.9, 432.91, 432.92, 432.98, 432.99
	Carotid artery disease (ICD-10)	I65, I65.0, I65.1, I65.2, I65.8, I65.9, I66, I66.0, I66.1, I66.2, I66.3, I66.8, I66.9
	Transient ischemic attack (ICD-8)	435, 435.09, 435.99
	Transient ischemic attack (ICD-10)	G45, G45.0, G45.1, G45.2, G45.3, G45.4, G45.8, G45.9
Intrinsic heart disease	Heart failure (ICD-8)	427.09, 427.1, 427.11, 427.19, 428, 428.99, 782.49
	Heart failure (ICD-10)	I11.0, I13.0, I13.2, I50, I50.0, I50.1, I50.9
	Pericardial disease (ICD-8)	393, 393.01, 393.08, 393.09, 420, 420.08, 420.09, 423, 423.01, 423.02, 423.08, 423.09
	Pericardial disease (ICD-10)	I30, I30.0, I30.8, I30.9, I31, I31.0, I31.1, I31.2, I31.3, I31.8, I31.9, I32
	Valvular disease (ICD-8)	394, 394.9, 394.91, 394.92, 394.98, 394.99, 395, 395.9, 395.91, 395.92, 395.98, 395.99, 396, 396.9, 396.91, 396.92, 396.93, 396.94, 396.98, 396.99, 397, 424, 424.01, 424.02, 424.08, 424.09, 424.1, 424.11, 424.12, 424.18, 424.19, 424.9, 424.91, 424.92, 424.99
	Valvular disease (ICD-10)	I34, I34.0, I34.1, I34.2, I34.8, I34.9, I35, I35.0, I35.1, I35.2, I35.8, I35.9, I36, I36.0, I36.1, I36.2, I36.8, I36.9, I37, I37.0, I37.1, I37.2, I37.8, I37.9
	Myocardial disease (ICD-8)	422, 422.99
	Myocardial disease (ICD-10)	I40, I40.1, I40.8, I40.9, I41, I41.8, I51.4
	Cardiomyopathy (ICD-8)	425, 425.99, 426, 426.08, 426.09, 427, 429, 429.08, 429.09, 426.00
	Cardiomyopathy (ICD-10)	I25.5, I42, I42.0, I42.1, I42.2, I42.3, I42.4, I42.5, I42.7, I42.8, I42.9, I43, I43.8, I51.7

Data availability statement

Access to data in this manuscript are not possible due to GDPR regulations.