in patients who have been treated with chemotherapy. In a study of patients who have GCT treated with surgery or surgery plus chemotherapy (inter-group adjuvant trial), Nichols and colleagues  reported no increased risk for cardiovascular events in the chemotherapy group at a median follow-up of 5 years. Meinardi and colleagues  have demonstrated a relative risk for cardiovascular events of 7.1 (95% CI, 1.9-18.3) inpatients less than 50 years old who had GCT who had received cisplatin-based chemotherapy and were in remission for 10 years or more compared with a general male population. Huddart and colleagues  also recently reported on cardiovascular risk in a large cohort of long-term GCT. Among 992 patients who had GCT at a median of 10.2 years of follow-up, 68 cardiovascular events were reported, including 18 deaths. Increased risk for cardiovascular events was seen in patients who had GCT who had received chemotherapy, radiation therapy, or chemotherapy/radiation compared with those treated only with surveillance. Most recently, van den Belt-Dusebout and colleagues  have reported on long-term cardiovascular disease in 2512 long-term survivors of GCT. With a median follow-up of 18.4 years, the standardized incidence ratio for coronary heart disease was 1.17 (95% CI, 1.04-1.31). Cisplatin-based chemotherapy was associated with a 1.9fold (95% CI, 1.7- to 2.0-fold) increased risk for myocardial infarction.
The underlying mechanism for the increased cardiovascular risk associated with cisplatin-based chemotherapy is not clear. Patients who have GCT treated with cisplatin-based chemotherapy may prematurely develop hyperlipidemia, hypertension, increased body mass index, and metabolic syndrome [25,28,29]. This point underscores that long-term survivors of GCT should have lifelong medical follow-up, especially if treated with cis-platin-based chemotherapy.
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