(HealthDay News) — Physicians and patients should be aware of the persistently increased risk for cardiovascular diseases (CVDs) throughout life after Hodgkin lymphoma, according to a report published in JAMA Internal Medicine.

Flora van Leeuwen, PhD, of the Netherlands Cancer Institute in Amsterdam, and colleagues examined the medical records of 2,524 Dutch patients who were treated for Hodgkin lymphoma between 1965 and 1995, and were diagnosed before the age 51 years. The researchers tracked them for as long as 40 years.

A total of 1,713 CV events occurred in 797 patients after a median follow-up of 20 years. After 35 years or more, standardized incidence ratio for coronary heart disease (CHD) or heart failure was still four- to six-fold higher for patients than the general population. This translated to 857 excess events per 10,000 person-years, according to the data.

The researchers found that relative risks were highest in patients with Hodgkin lymphoma treated before age 25 years, although absolute excess risks were substantial for those treated at older ages. 

The 40-year cumulative incidence of CVDs was 50% (95% CI, 47-52) within the cohort, with 51% of patients with a CVD developing multiple events. For patients treated before age 25 years, cumulative incidences at 60 years or older were 20% for CHD, 31% for valvular heart disease and 11% for heart failure as first events.

Results indicated that risks for CHD (HR=2.7; 95% CI, 2.0-3.7), valvular heart disease (HR=6.6; 95% CI, 4.0-10.8) and heart failure (HR=2.7; 95% CI, 1.6-4.8) as first events were increased with mediastinal radiotherapy. Anthracycline-containing chemotherapy also appeared to raise risk for valvular heart disease (HR=1.5; 95% CI, 1.1-2.1) and heart failure (HR=3.0; 95% CI, 1.9-4.7) as first events. 

“The results of our study may direct guidelines for follow-up of patients with Hodgkin’s lymphoma,” the researchers wrote.

In an invited commentary, Emily Tonorezos, MD, MPH, of the Weill Cornell Medical College in New York, and Linda Overholser, MD, of the University of Colorado Denver School of Medicine in Aurora, discussed the findings. 

“This work by van Nimwegen et al can specifically help physicians identify their highest-risk patients: those with a history of [Hodgkin lymphoma] who were treated at a younger age and those who are the longest from treatment. For most encounters, starting by asking a few key cancer history questions will help identify these patients: (1) What kind of cancer did you have? (2) How old were you when your lymphoma was diagnosed? (3) Did you receive chest radiotherapy? (4) Did you receive doxorubicin (many patients know it by the brand name Adriamycin [the red medicine])?” they wrote. 

“Our clinical experience has been that patients typically know the answers to these basic questions, and these responses will go a long way toward identifying at-risk patients. Nonetheless, the future of good care for cancer survivors will require establishment of the evidence-based best practices for this population.”


  1. van Nimwegen FA et al. JAMA Intern Med. 2015;doi:10.1001/jamainternmed.2015.1180.
  2. Tonozeros E, Overholser L. JAMA Intern Med. 2015;doi:10.1001/jamainternmed.2015.1187.