Studies in the United States¹ and Europe^2-6 have shown that both early and late cardiovascular effects are associated with platinum-based therapies. In their recent publication, Lauritsen et al² undertake an epidemiologic survey to assess early and long-term cardiovascular effects in male survivors of germ cell cancer (GCC) compared with age-matched controls using data from the Danish National Registry (median follow-up, 15.8 years). Those treated with bleomycin, etoposide, and cisplatin (BEP) had a marked six-fold increased risk of myocardial infarction in the first year after therapy.² Their study adds further evidence that there is an increased risk of cardiovascular disease (CVD) within the first year after platinum-based chemotherapy. These findings are similar to those of Fung et al¹ who used data from the population-based Surveillance, Epidemiology, and End Results (SEER) Program, which addressed CVD mortality in patients with GCC. As in Fung et al,¹ results in Lauritsen et al² were based on relatively few incident cases of myocardial infarction (7 of 1,360 patients). This leaves us with two practical clinical questions: What are the mechanisms of action? How do we risk-stratify these patients in the acute period after treatment? One postulated mechanism has been that the increased risk of CVD may be due to direct vascular injury, endothelial dysfunction, and a hypercoagulable state in the first year after treatment with BEP.^1,2,7 Although the relatively low number of cases of CVD might be reassuring, the high morbidity and mortality of a major cardiovascular and/or cerebrovascular event while undergoing treatment for GCC can be potentially devastating. Evidence-based practices need to be developed to better risk-stratify those at high risk during their first year after chemotherapy.

中文翻译：

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男性生殖细胞癌幸存者心血管后遗症的风险增加。

美国¹和欧洲^2-6的研究表明，早期和晚期心血管效应均与铂类疗法有关。Lauritsen等人[ ^2]在最近的出版物中进行了一项流行病学调查，以评估丹麦生殖细胞癌（GCC）男性幸存者与年龄匹配的对照组相比早期和长期的心血管影响，并使用丹麦国家注册局的数据（中位随访） ，15.8年）。治疗后第一年，用博来霉素，依托泊苷和顺铂（BEP）治疗的患者发生心肌梗塞的风险明显增加了六倍。²他们的研究进一步证明了铂类化疗后第一年内发生心血管疾病（CVD）的风险增加。这些发现与Fung等[ ^1]的研究相似，他们使用了基于人群的监测，流行病学和最终结果（SEER）计划的数据，该计划解决了GCC患者的CVD死亡率。与Fung等人一样，Lauritsen等人^1的结果²基于相对较少的心肌梗死事件案例（1,360名患者中的7名）。这给我们留下了两个实际的临床问题：作用机理是什么？在治疗后的急性期我们如何对这些患者进行风险分层？一种推测的机制是，CVD风险增加可能是由于直接血管损伤，内皮功能障碍和BEP治疗后第一年的高凝状态所致。^1,2,7尽管相对较少的CVD病例可以使人放心，但是在接受GCC治疗时发生重大心血管和/或脑血管事件的高发病率和高死亡率可能具有破坏性。需要发展循证实践，以更好地对高危人群在化疗后的第一年进行风险分层。