Cardiovascular disease in adolescent and young adult survivors of non-Hodgkin lymphoma in Korea.

Purpose: Long-term cardiovascular risk in adolescent and young adult (AYA) survivors of non-Hodgkin lymphoma (NHL) remains insufficiently characterized. This retrospective cohort study investigated the incidence of cardiovascular disease (CVD) among AYA survivors of NHL.

Methods: We identified 4553 individuals aged 15-39 years diagnosed with NHL between 2006 and 2019 using the Korean National Health Insurance System database. A control group of 13,659 individuals without a history of cancer or CVD was selected using 1:3 matching based on age, sex, and residential area. The primary outcomes were major adverse cardiovascular events such as myocardial infarction, cardiomyopathy, heart failure, ischemic stroke, and hemorrhagic stroke. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazard models.

Results: The mean (SD) age of the participants was 29.5 (6.8) years, and 59% were male. Over a median follow-up of 6.5 years, survivors of NHL had significantly higher risks of cardiomyopathy (HR 6.77; 95% CI 3.44-13.33), heart failure (HR 4.90; 95% CI 3.45-6.97), and hemorrhagic stroke (HR 3.14; 95% CI 1.75-5.65), compared to controls. In the subgroup analyses stratified by treatment modality, the highest risks were observed among patients who underwent hematopoietic stem cell transplantation, which involved high-dose chemotherapy with or without radiotherapy. The risk of myocardial infarction and ischemic stroke did not increase significantly.

Conclusion: AYA survivors of NHL had a significantly higher risk of CVD, including cardiomyopathy, heart failure, and hemorrhagic stroke, than the general population.

Implications for cancer survivors: Long-term cardiovascular surveillance is essential for AYA survivors of NHL, particularly those receiving intensive treatment.