A new study by researchers at Indiana University and Medical College of Wisconsin could improve heart health for testicular cancer survivors by helping clinicians predict which patients are at highest risk of cardiovascular disease, a leading cause of illness and death after cure.
Their findings, published today in the Journal of the National Cancer Institute, demonstrate for the first time that the American Heart Association's 2024 Predicting Risk of Cardiovascular Disease Events (PREVENT) equations can identify testicular cancer survivors at heightened risk for future cardiovascular events.
Testicular cancer is the most common cancer in young men, and modern cisplatin-based chemotherapy has pushed survival rates above 95%. However, this success has been accompanied by long-term health consequences, including cardiovascular disease. Until now, clinicians have lacked validated tools to predict which survivors are most vulnerable.
"These findings provide clinicians with a practical, evidence-based tool to identify testicular cancer survivors who are most likely to benefit from early cardiovascular screening and prevention," said Lois B. Travis, MD, ScD, senior author on the study and the Lawrence H. Einhorn Professor of Cancer Research at the IU School of Medicine and IU Melvin and Bren Simon Comprehensive Cancer Center. "Importantly, they also highlight physical activity as a critical intervention that may substantially reduce cardiovascular risk in this young survivor population."
The study evaluated 1,759 long-term testicular cancer survivors treated with cisplatin-based chemotherapy across eight major cancer centers in North America and Europe. Using the PREVENT equations — which incorporate age, blood pressure, cholesterol levels, kidney function, diabetes status, smoking and body mass index — researchers estimated survivors' 10- and 30-year cardiovascular disease risk.
Among survivors followed longitudinally, higher PREVENT-predicted risk strongly correlated with the development of cardiovascular disease:
- Each 5% increase in predicted 10-year risk was associated with nearly a three-fold increase in the odds of developing cardiovascular disease within approximately seven years of follow-up.
- Survivors classified as having intermediate-to-high risk had more than 12 times the odds of experiencing a cardiovascular event compared with lower-risk survivors
Notably, the association between PREVENT risk and cardiovascular disease was strongest among those who reported no vigorous physical activity at baseline. Survivors who engaged in vigorous physical activity showed a markedly lower risk, underscoring exercise as a powerful, modifiable protective factor.
The predictive accuracy of the PREVENT equations in testicular cancer survivors was comparable to that observed in the general population, reinforcing their usefulness in survivorship care. Because the tool relies on routinely collected clinical data, it can be readily integrated into standard follow-up without additional testing or cost.
The researchers emphasize that cardiovascular risk assessment should become a routine component of long-term survivorship care for testicular cancer patients, alongside monitoring of kidney function, lipid levels, blood pressure and lifestyle factors.
"As more men survive testicular cancer and live for decades after treatment, preventing cardiovascular disease is essential to preserving quality of life and long-term health," said Sarah L. Kerns, PhD, MPH, corresponding author on the study and associate professor of radiation oncology at the Medical College of Wisconsin. "Our study shows that we already have the tools to identify high-risk survivors — and the opportunity to intervene early."
The study was conducted as part of the multi-center Platinum Study and funded by the National Cancer Institute, part of the National Institutes of Health.
