A Dutch study found that Hodgkin lymphoma survivors who received chest irradiation are more likely to develop severe coronary artery disease (CAD) 20 years after treatment than those without Hodgkin lymphoma or chest irradiation. The findings suggest that these patients should undergo CAD screening and follow-up after irradiation treatment.
Researchers presented their study, “Differences in presence, extent, severity, composition and location of coronary artery disease after mediastinal irradiation compared with matched controls,” at the International Congress of Nuclear Cardiology, held May 7-9 in Vienna.
“Patients with Hodgkin lymphoma receive high-dose mediastinal irradiation at a young age as part of their treatment,” said Dr. Alexander van Rosendael of Leiden University Medical Center in a press release. “There is an ongoing debate about whether to screen patients who get chest irradiation for coronary artery disease.”
In the study, researchers assessed the extent, severity, and location of CAD in Hodgkin lymphoma patients who underwent chest radiation therapy. It included 79 Hodgkin lymphoma survivors who had been disease-free for at least 10 years and had received radiotherapy 20 years ago. To evaluate CAD differences, the observations in irradiated patients were compared to those of 273 matched controls.
Hodgkin survivor patients were on average 45 years old and presented an overall low incidence of cardiovascular risk factors such as diabetes, hypertension or smoking. About 58 percent of those patients had signs of atherosclerosis, compared to 46 percent of controls.
Evaluation of CAD by coronary computed tomography angiography (CTA) showed that patients had significantly more extensive and severe CAD conditions than controls. Compared to controls, patients were found to have four times th risk of plaque formation on the vessels proximal to the coronary artery, and three times the stenosis proximal to the coronary artery.
“Hodgkin patients who have chest irradiation have much more CAD than people of the same age who did not have irradiation,” van Rosendael said. “What was remarkable was that irradiated patients had all the features of high-risk CAD, including high stenosis [narrowing of vessels] severity, proximal location and extensive disease. We know that the proximal location of the disease is much riskier and this may explain why Hodgkin patients have such poor cardiovascular outcomes when they get older.”
Radiotherapy commonly used to treat Hodgkin lymphoma can inflame the coronary arteries. This can make patients undergoing this treatment more vulnerable to CAD, even though no one knows why radiation interferes particularly with proximally located vessels.
“When you see CAD in patients who received chest irradiation, it is high-risk CAD,” said van Rosendael. “Such patients should be screened at regular intervals after irradiation so that CAD can be spotted early and early treatment can be initiated.”
These findings demonstrate that an early detection of CAD may help physicians manage this condition at its early stages, improving patient outcome. According to Rosendael, treatments like statin therapy and revascularization are known help the general population affected by CAD, so they are likely to benefit Hodgkin patients as well.