Identifying Risk Factors of Cardiovascular Disease in Testicular Cancer Survivors

By Emily Menendez - April 28, 2023

The survival rate of testicular cancer (TC) has improved substantially since the introduction of platinum-based chemotherapy. Five-year survival rates for patients are now between 99% for localized TC and 70% for poor-risk disseminated disease. However, TC treatment, especially platinum-based chemotherapy, is associated with an increased risk of cardiovascular morbidity and mortality, most likely caused by treatment-related vascular damage.

The causes behind vascular damage after TC treatment are not yet fully understood but may be linked to the development of endothelial dysfunction, which has been seen in vitro and in vivo. To further the development of preventive strategies for cardiovascular disease (CVD) in patients with TC, a study published in the Journal of Clinical Oncology assessed cardiometabolic risk factors and quality of life (QoL) in TC survivors.

A multicenter cohort of 4748 patients treated between 1976 and 2007 was analyzed for incidence of coronary artery disease, myocardial infarction, and heart failure after TC treatment. Each patient who had developed CVD along with a random sample from the cohort (subcohort) received a questionnaire on cardiometabolic risk factors and QoL. A subgroup of responders from the subcohort also underwent clinical evaluation of cardiovascular risk factors.

After a 16-year median follow-up, 272 patients had developed CVD. Cisplatin-based combination chemotherapy was associated with a higher risk of CVD when compared with orchidectomy only (hazard ratio [HR], 1.9; 95% CI, 1.1-3.1). Patients who were obese or smoked at diagnosis (HR, 4.6; 95% CI, 2.0-10.0 and HR, 1.7; 95% CI, 1.1-2.4, respectively), developed Raynaud’s phenomenon (HR, 1.9; 95% CI, 1.1-3.6) or dyslipidemia (HR, 2.8; 95% CI, 1.6-4.7), or had a positive family history for CVD (HR, 2.9; 95% CI, 1.7-4.9) had a risk of developing CVD.

More TC survivors with CVD reported inferior QoL on physical domains than survivors who did not develop CVD. Out of 304 total TC survivors who underwent clinical evaluation for cardiovascular risk factors (median age at assessment, 51 years), 86% had dyslipidemia, 50% had hypertension, and 35% had metabolic syndrome, irrespective of treatment.

The results of this study point to the importance of early lifestyle adjustments and lifelong follow-up with low-threshold treatment of cardiovascular risk factors for survivors of TC, especially in obese and smoking patients treated with platinum-based chemotherapy.