Cardiovascular Disease Mortality Risk among Long-term Survivors of Different Hodgkin Lymphoma Types

Abstract

Background: The temporal trend and disparities in cardiovascular disease (CVD) mortality risk among long-term survivors of different Hodgkin lymphoma (HL) types are unclear. Therefore, we aimed to examine the temporal trend and disparities in CVD mortality risk among survivors of various HL subtypes. Methods: This multicenter cohort included 20,423 patients with HL diagnosed between 1975 and 2018, with an average follow-up time of 18.5 years. Proportional mortality ratio, cumulative cause-specific mortality accounting for competing risks, standardized mortality ratio, and absolute excess risk were calculated. Results: Patients with nodular lymphocyte-predominant HL (NLPHL) and classical HL exhibited higher CVD-related deaths than HL-related deaths after approximately 12 and 120 months of follow-up, respectively. From the initial diagnosis to >500 months of follow-up, the cumulative CVD mortality increased continuously without a plateau and exceeded that of HL at different times in most patients with various HL types. However, CVD mortality risk exceeded that of HL earlier in NLPHL than in other types. Black or male patients with nodular sclerosing classical HL exhibited a higher CVD mortality risk, while a contrary trend was noted among those with lymphocyte-rich classical HL or lymphocyte-depleted classical HL. Over the past decades, CVD mortality risk has decreased slowly or remained unchanged. Patients with HL exhibited higher risks of CVD mortality than the general population. Conclusions: CVD mortality risk exceeded that of HL over time among many survivors. This temporal trend was significantly different among various HL subtypes. Thus, more effective strategies are required to reduce the risk of CVD mortality, depending on subtypes.