Trends and Disparities in Cardiovascular Mortality among Survivors of Hodgkin Lymphoma

Background Over the past decades, survival of patients with Hodgkin lymphoma (HL) has increased but remains curtailed by cardiovascular mortality (CVM). HL survivors at greatest risk for cardiovascular death have not been clearly identified. We sought to report trends of CVM identify HL survivors at highest risk. Methods The Surveillance, Epidemiology, and End Results (SEER) database was queried for all adult patients diagnosed with HL (age 20-49 years) between 1990 and 2011. The trend of CVM and disparities are presented. Results Of 19,781 HL patients, 53% were male and 83% were white; patients had a mean age of 33 ± 8.3 years at diagnosis. Eighteen percent had stage I disease, 45% stage II, 18% stage III, and 15% stage IV. The risk for CVM was higher in blacks (adjusted hazard ratio [HR], 1.97; P =.002), men (adjusted HR, 2.2; P <.001), and patients with older age at diagnosis (adjusted HR, 1.073 per year; P <.001). CVM has decreased, with 5-year cumulative incidence decreasing from 1.17% in 1990 to 0.18% in 2006, averaging 7% per year (adjusted HR, 0.927; P <.001). This trend was seen only in patients with early disease (P <.001) but not with advanced disease (P = NS). CVM as a proportion of all-cause mortality increases sharply at 50 years of age, constituting more than 30% of all causes of death. Conclusion Despite an overall decrease in CVM in HL survivors over the last decades, older patients, black patients, and men, especially those who have advanced-stage disease at diagnosis, are at the highest risk of cardiovascular death. Cardiovascular screening and risk modification should be intensified in HL patients with these characteristics.