Testicular cancer may raise risk of heart attack

Survivors of testicular cancer have a moderately increased risk of heart attack at young ages, according to Dutch researchers.

Testicular cancer is the most common cancer for men between 20 and 35 years of age. The increased heart attack risk seen in the current study applied to men with nonseminomatous testicular cancer, a common type that is very resistant to radiation therapy and can spread to the lungs, liver, bones, or brain.

Dr. Flora E. van Leeuwen, of the Netherlands Cancer Institute, Amsterdam, and colleagues examined the long-term risk of heart disease in 2512 testicular cancer survivors who were treated between 1965 and 1995. The results are published in the Journal of Clinical Oncology.

During about 18 years of follow-up, 141 heart attacks occurred in the study group. Compared with men lacking a history of testicular cancer, survivors of the disease were roughly twice as likely to experience a heart attack before 54 years of age.

Radiation to the chest, where testicular cancer often spreads, was associated with a 3.7-fold increased risk of heart attack compared with surgery alone. By contrast, radiation to the abdomen and lower did not raise the risk of heart attack.

The authors also found that several commonly used chemotherapy drugs were associated with an increased risk of heart attack.

There have been various mechanisms proposed to explain the increased risk in this population, the authors note. "A high prevalence of classical cardiovascular risk factors has been demonstrated in testicular cancer survivors after chemotherapy," van Leeuwen's team writes.

Furthermore, blood vessel dysfunction and plaques, both of which contribute to heart attacks, have been reported to occur a few years after chemotherapy, they add.

SOURCE: Journal of Clinical Oncology, January 2006.