• coronary artery disease

Childhood cancer survivors (CCS) are at increased risk of chronic health conditions such as recurrent cancers, second cancers and cardiovascular disease to mention the most common ones.1 Already at the age of 30, the more severe chronic health conditions have occurred with an estimated cumulative incidence of 42.4%,1 which accumulate up to 53.6% at 50 years.2 The cardiovascular burden of disease comprises mainly heart failure, valvular disease and pericardial disease, while for coronary artery disease, the incidence of myocardial infarction (compared with all the competing other events) seems to be low at 1.3% at 30 years after diagnosis. However, this incidence increases to 5.3% by the age of 45 and has a continuously raised HR of 5 compared with age matched siblings.3 4 These figures raise the issue for continuous cardiovascular surveillance of CCS up until older age and also for the need for risk models and prevention programmes.

In the study of Feijen et al 5 in this issue of the journal, we see the cardiac ischaemia perspective of the European adult who survived cancer in childhood or early adulthood (<20 years), the majority of whom are between 20 and 49 years of age. Some of the patients were followed up into their 60s and 70s, which may seem unprecedented. The result is new for elderly CCS: there is a cumulative incidence of severe cardiac ischaemic events of 5.4% at the age of 60 years, which is probably still underestimated (see below). The results confirm previous studies that there is an increasing cumulative incidence of severe cardiac ischaemic events with age, at 20 years 0.02%, at 30 years 0.16%, at 40 years 0.71 %, at 50 years 2.46% and at 60 years 5.4% with the second possible take home message that there is still the …