Risk of important cardiovascular diseases by sex, age at start of treatment, attained age, treatment, and follow-up interval
| . | Person-y† . | Myocardial infarction . | Angina pectoris . | Congestive heart failure* . | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| O . | SIR . | 95% CI . | AER‡ . | O . | SIR . | 95% CI . | AER‡ . | O . | SIR . | 95% CI . | AER‡ . | ||
| Sex | |||||||||||||
| Men | 10 528 | 84 | 4.2 | 3.4-5.2 | 60.7 | 86 | 3.7 | 3.0-4.6 | 59.4 | 25 | 3.9 | 2.5-5.7 | 21.7 |
| Women | 10 034 | 18 | 2.1 | 1.2-3.3 | 9.4 | 48 | 5.2 | 3.8-6.9 | 39.1 | 27 | 6.4 | 4.2-9.4 | 29.8 |
| Age at start of treatment | |||||||||||||
| No older than 20 y | 4 892 | 9 | 5.4 | 2.4-10.3 | 15.0 | 20 | 11.6 | 7.0-17.9 | 37.2 | 11 | 18.2 | 9.0-32.6 | 27.6 |
| 21-25 y | 5 227 | 25 | 5.9 | 3.8-8.7 | 39.7 | 30 | 6.2 | 4.2-8.8 | 48.1 | 11 | 7.0 | 3.5-12.5 | 23.1 |
| 26-30 y | 4 111 | 22 | 4.1 | 2.6-6.2 | 40.4 | 30 | 4.8 | 3.2-6.9 | 58.6 | 13 | 6.7 | 3.6-11.5 | 34.7 |
| 31-35 y | 3 746 | 24 | 2.7 | 1.8-4.1 | 40.7 | 26 | 2.6 | 1.7-3.9 | 43.5 | 8 | 2.5 | 1.1-4.9 | 16.0 |
| 36-40 y | 2 630 | 22 | 2.6 | 1.6-4.0 | 51.8 | 28 | 2.9 | 1.9-4.2 | 70.2 | 9 | 2.7 | 1.2-5.1 | 26.4 |
| Attained age§ | |||||||||||||
| Younger than 40 y | 10 353 | 13 | 4.4 | 2.3-7.5 | 9.7 | 17 | 6.0 | 3.5-9.6 | 13.7 | 9 | 26.0 | 11.8-49.5 | 12.6 |
| 40-49 y | 6 974 | 44 | 4.0 | 2.9-5.4 | 47.4 | 51 | 3.8 | 2.8-5.0 | 53.8 | 19 | 5.1 | 3.1-8.1 | 25.8 |
| At least 50 y | 3 278 | 45 | 3.1 | 2.3-4.2 | 93.0 | 66 | 4.1 | 3.2-5.2 | 159.4 | 24 | 3.9 | 2.5-5.8 | 55.9 |
| Treatment‖ | |||||||||||||
| Initial RT only | 6 551 | 36 | 3.9 | 2.7-5.4 | 49.9 | 54 | 5.2 | 3.9-6.7 | 66.8 | 18 | 4.8 | 2.8-7.6 | 27.1 |
| RT + CT, no anthracyclines | 8 994 | 50 | 3.9 | 2.9-5.1 | 66.0 | 57 | 3.8 | 2.9-5.0 | 47.0 | 25 | 5.3 | 3.4-7.8 | 31.8 |
| RT + CT, anthracyclines | 3 933 | 14 | 3.5 | 1.9-5.9 | 23.6 | 20 | 4.5 | 2.7-6.9 | 39.9 | 9 | 6.2 | 2.8-11.8 | 21.2 |
| Initial CT only | 1 083 | 2 | 1.0 | 0.1-3.5 | 7.4 | 2 | 0.8 | 0.1-2.9 | −4.6 | 0 | 0.0 | 0.0-5.2 | −8.2 |
| Anthracycline-containing chemotherapy | |||||||||||||
| No | 9 870 | 52 | 3.5 | 2.6-4.6 | 37.7 | 60 | 3.5 | 2.7-4.5 | 43.3 | 25 | 4.6 | 3.0-6.8 | 27.5 |
| Yes | 4 141 | 14 | 3.3 | 1.8-5.5 | 23.5 | 20 | 4.2 | 2.6-6.5 | 37.1 | 9 | 5.8 | 2.6-11.1 | 19.8 |
| Follow-up interval | |||||||||||||
| 5-9 y | 6 872 | 7 | 1.7 | 0.7-3.6 | 4.3 | 12 | 2.6 | 1.3-4.5 | 10.7 | 5 | 7.1 | 2.3-16.8 | 11.0 |
| 10-14 y | 5 457 | 24 | 4.4 | 2.8-6.5 | 33.9 | 21 | 3.3 | 2.0-5.1 | 26.8 | 5 | 3.4 | 1.1-7.9 | 8.7 |
| 15-19 y | 3 861 | 24 | 4.0 | 2.5-5.9 | 46.4 | 25 | 3.5 | 2.2-5.1 | 46.0 | 19 | 8.5 | 5.1-13.2 | 47.3 |
| 20-24 y | 2 443 | 26 | 4.7 | 3.1-7.0 | 84.0 | 30 | 4.6 | 3.1-6.5 | 96.7 | 6 | 2.4 | 0.9-5.2 | 13.7 |
| At least 25 y | 1 973 | 21 | 2.9 | 1.8-4.4 | 69.2 | 46 | 6.0 | 4.4-8.0 | 207.7 | 17 | 4.5 | 2.6-7.3 | 62.5 |
| . | Person-y† . | Myocardial infarction . | Angina pectoris . | Congestive heart failure* . | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| O . | SIR . | 95% CI . | AER‡ . | O . | SIR . | 95% CI . | AER‡ . | O . | SIR . | 95% CI . | AER‡ . | ||
| Sex | |||||||||||||
| Men | 10 528 | 84 | 4.2 | 3.4-5.2 | 60.7 | 86 | 3.7 | 3.0-4.6 | 59.4 | 25 | 3.9 | 2.5-5.7 | 21.7 |
| Women | 10 034 | 18 | 2.1 | 1.2-3.3 | 9.4 | 48 | 5.2 | 3.8-6.9 | 39.1 | 27 | 6.4 | 4.2-9.4 | 29.8 |
| Age at start of treatment | |||||||||||||
| No older than 20 y | 4 892 | 9 | 5.4 | 2.4-10.3 | 15.0 | 20 | 11.6 | 7.0-17.9 | 37.2 | 11 | 18.2 | 9.0-32.6 | 27.6 |
| 21-25 y | 5 227 | 25 | 5.9 | 3.8-8.7 | 39.7 | 30 | 6.2 | 4.2-8.8 | 48.1 | 11 | 7.0 | 3.5-12.5 | 23.1 |
| 26-30 y | 4 111 | 22 | 4.1 | 2.6-6.2 | 40.4 | 30 | 4.8 | 3.2-6.9 | 58.6 | 13 | 6.7 | 3.6-11.5 | 34.7 |
| 31-35 y | 3 746 | 24 | 2.7 | 1.8-4.1 | 40.7 | 26 | 2.6 | 1.7-3.9 | 43.5 | 8 | 2.5 | 1.1-4.9 | 16.0 |
| 36-40 y | 2 630 | 22 | 2.6 | 1.6-4.0 | 51.8 | 28 | 2.9 | 1.9-4.2 | 70.2 | 9 | 2.7 | 1.2-5.1 | 26.4 |
| Attained age§ | |||||||||||||
| Younger than 40 y | 10 353 | 13 | 4.4 | 2.3-7.5 | 9.7 | 17 | 6.0 | 3.5-9.6 | 13.7 | 9 | 26.0 | 11.8-49.5 | 12.6 |
| 40-49 y | 6 974 | 44 | 4.0 | 2.9-5.4 | 47.4 | 51 | 3.8 | 2.8-5.0 | 53.8 | 19 | 5.1 | 3.1-8.1 | 25.8 |
| At least 50 y | 3 278 | 45 | 3.1 | 2.3-4.2 | 93.0 | 66 | 4.1 | 3.2-5.2 | 159.4 | 24 | 3.9 | 2.5-5.8 | 55.9 |
| Treatment‖ | |||||||||||||
| Initial RT only | 6 551 | 36 | 3.9 | 2.7-5.4 | 49.9 | 54 | 5.2 | 3.9-6.7 | 66.8 | 18 | 4.8 | 2.8-7.6 | 27.1 |
| RT + CT, no anthracyclines | 8 994 | 50 | 3.9 | 2.9-5.1 | 66.0 | 57 | 3.8 | 2.9-5.0 | 47.0 | 25 | 5.3 | 3.4-7.8 | 31.8 |
| RT + CT, anthracyclines | 3 933 | 14 | 3.5 | 1.9-5.9 | 23.6 | 20 | 4.5 | 2.7-6.9 | 39.9 | 9 | 6.2 | 2.8-11.8 | 21.2 |
| Initial CT only | 1 083 | 2 | 1.0 | 0.1-3.5 | 7.4 | 2 | 0.8 | 0.1-2.9 | −4.6 | 0 | 0.0 | 0.0-5.2 | −8.2 |
| Anthracycline-containing chemotherapy | |||||||||||||
| No | 9 870 | 52 | 3.5 | 2.6-4.6 | 37.7 | 60 | 3.5 | 2.7-4.5 | 43.3 | 25 | 4.6 | 3.0-6.8 | 27.5 |
| Yes | 4 141 | 14 | 3.3 | 1.8-5.5 | 23.5 | 20 | 4.2 | 2.6-6.5 | 37.1 | 9 | 5.8 | 2.6-11.1 | 19.8 |
| Follow-up interval | |||||||||||||
| 5-9 y | 6 872 | 7 | 1.7 | 0.7-3.6 | 4.3 | 12 | 2.6 | 1.3-4.5 | 10.7 | 5 | 7.1 | 2.3-16.8 | 11.0 |
| 10-14 y | 5 457 | 24 | 4.4 | 2.8-6.5 | 33.9 | 21 | 3.3 | 2.0-5.1 | 26.8 | 5 | 3.4 | 1.1-7.9 | 8.7 |
| 15-19 y | 3 861 | 24 | 4.0 | 2.5-5.9 | 46.4 | 25 | 3.5 | 2.2-5.1 | 46.0 | 19 | 8.5 | 5.1-13.2 | 47.3 |
| 20-24 y | 2 443 | 26 | 4.7 | 3.1-7.0 | 84.0 | 30 | 4.6 | 3.1-6.5 | 96.7 | 6 | 2.4 | 0.9-5.2 | 13.7 |
| At least 25 y | 1 973 | 21 | 2.9 | 1.8-4.4 | 69.2 | 46 | 6.0 | 4.4-8.0 | 207.7 | 17 | 4.5 | 2.6-7.3 | 62.5 |
P values for trends were as follows: for myocardial infarction, P = .001 for age at start of treatment, P = .17 for attained age, and P = .65 for follow-up interval; for angina pectoris, P < .001 for age at start of treatment, P = .43 for attained age, and P = .001 for follow-up interval; and for congestive heart failure, P < .001 for age at start of treatment, P < .001 for attained age; and P = .29 for follow-up interval.
O indicates observed number of specific CVD; SIR, standardized incidence ratio; AER, absolute excess risk; RT, radiotherapy; CT, chemotherapy.
Because reference rates are available from 1986, analyses were based on person-years and events since 1986. For this calculation the numbers of person-years for the follow-up periods from 20 years after diagnosis were similar as in the other analyses but differed for the follow-up periods until 19 years after diagnosis. The numbers of person-years for follow-up periods until 19 years were 5 to 9 years: 3907 person-years; 10 to 14 years: 4044 person-years; 15 to 19 years: 3541 person-years; 7 patients with CHF before 1986 are excluded from this analysis.
Number of person-years for angina pectoris and congestive heart failure were similar to those for myocardial infarction.
Per 10 000 patients per year. The absolute incidence rate/10 000 can be calculated with the following formula: AER + AER/(SIR − 1) × 10 000.
Attained age was defined as the age of patients at diagnosis of a given cardiovascular event or at the end of follow-up and was calculated to assess at what ages patients experienced increased risk compared with their peers in the general population. Each patient contributed person-years to each consecutive attained-age category that the patient passed through during follow-up.
RT includes all irradiated patients (n = 1400); see flow chart for detailed information. Three patients with incomplete treatment data were excluded from the analyses about treatment effects.