Are survivors of acute lymphoblastic leukemia (ALL) at increased risk of cardiovascular disease?

Through a variety of different mechanisms, it appears that survivors of childhood acute lymphoblastic leukemia have an increased prevalence of several cardiovascular risk factors and thus are at increased risk for developing cardiovascular disease. The aim of this paper is to describe the current understanding of particular risk factors, including obesity, physical inactivity, dyslipidemia, insulin resistance, and metabolic syndrome, that may contribute to cardiovascular disease in survivors of childhood ALL. The potential roles of different cancer therapies in the development of these risk factors are discussed. In addition, two other late effects that may affect cardiovascular health are discussed: late-onset anthracycline-induced left ventricular dysfunction and methotrexate-mediated elevations of homocysteine during therapy with the potential for endothelial dysfunction. Lastly, areas needing further investigation to elucidate these risks are highlighted.