The Contribution of Stress and Distress to Cardiovascular Health in Adult Survivors of Childhood Cancer

Abstract

Background: Childhood cancer survivors are at risk for cardiovascular morbidity and mortality that is not fully explained by cancer-directed therapies. We examined the contribution of emotional stress and distress to cardiac health in adult survivors of childhood cancer. Methods: Participants included 3,267 adult survivors enrolled in the St. Jude Lifetime Cohort Study (median[range] 29.9 [18.1-64.5] years of age; 7.7 [0-24.8] years at diagnosis; 48.4% female). Survivors completed comprehensive medical assessments and standardized measures of depression, anxiety, post-traumatic stress symptoms (PTSS), and perceived stress. Cardiovascular-related conditions included hypertension, diabetes, dyslipidemia, cardiomyopathy, dysrhythmia, myocardial infarction (severity graded 0-4), and metabolic syndrome (yes/no). Multivariable modified Poisson models examined associations between symptoms of stress/distress and cardiovascular outcomes. Longitudinal associations between stress/distress and new onset cardiovascular outcomes, defined as a change from grade ≤1 at initial evaluation to grade ≥2 at follow-up (median 3.9 years) were examined in 1,748 participants. Results: In multivariable cross-sectional models, stress/distress was associated with hypertension (RR=1.24, 95% CI 1.07-1.43), dyslipidemia (RR=1.29, 95% CI 1.03-1.61), and metabolic syndrome (RR=1.35, 95% CI 1.17-1.54) independent of known cardiovascular risk factors. In longitudinal models, stress/distress was associated with new onset dysrhythmia (RR=2.87, 95% CI 1.21-6.78), perceived stress with hypertension (RR=1.42, 95% CI 1.04-1.95), and PTSS and anxiety with dyslipidemia (RR=1.72, 95% CI 1.13-2.62; RR=1.54 95% CI 1.01-2.35, respectively). Conclusions: Stress/distress is independently associated with adverse cardiovascular outcomes among childhood cancer survivors. Impact: Improving psychological health may serve as a potential intervention target for optimizing cardiac health among childhood cancer survivors.