Metabolic Syndrome Screening in Allogeneic Hematopoietic Cell Transplant Survivors

Survivors of allogeneic hematopoietic cell transplant (HCT) are at a significantly increased risk of late mortality from cardiovascular disease (CVD). Metabolic syndrome (MetS) is a known risk factor for CVD in the general population. We sought to examine our current practices of screening for MetS and describe the overall incidence of MetS post-transplant.We undertook a retrospective review of patients undergoing allogeneic HCT at the Cleveland Clinic and seen through our survivorship program between 2018-2022. Metabolic syndrome was defined as having at least three of the following criteria: 1) hyperglycemia (A1C > 5.7), 2) Low HDL (< 40 mg/dL in men and < 50 mg/dL in women), 3) hypertriglyceridemia (≥ 150 mg/dL), 4) abdominal obesity (abdominal girth > 40 inches in men and > 35 inches in women), 5) hypertension (systolic blood pressure ≥ 130 mmHg and diastolic blood pressure ≥ 85 mmHg). We describe the number of patients who had screening and met each criterion and incidence of MetS at 1-year post transplantation.Of 153 patients that underwent allogenic HCT between 2018-2022, 99 survived without relapse by 1 year. Of the 1-year survivors, 90 (91%) had A1C assessment, and 38 (38%) had elevated A1C > 5.7 (Figure 1). HDL and triglyceride levels were collected from 97 (98%) patients (43 female, 54 male) at 1-year. Hypertriglyceridemia was found in 50 (51%) of our patients (69 female, 28 male), while low HDL levels were present in 31 (31%) patients (8 female, 23 male). Overall, there were 34 (34%) patients that were on statins, 14 of which had either hypertriglyceridemia or low HDL levels. Figure 2 illustrates the stratification of the cholesterol markers in the patients. Abdominal girth was measured in 84 (85%) patients 1-year post-transplant, with 25 males and 20 females meeting the criteria for MetS. Finally, blood pressure was measured in all 99 patients, with 10 (10%) patients having a blood pressure ≥ 130/85. This included 33 total patients that were on anti-hypertensives, 6 of whom still had recorded elevated blood pressure at the 1-year post-transplant visit. In total, 23 (23%) patients met criteria for MetS (9 female, 14 male). Distribution of criteria for MetS is shown in Figure 3.In sum, we demonstrate high rates of screening for MetS in 1-year survivors of allogeneic HCT and nearly a quarter of patients meeting criteria for MetS. Additional analyses to better characterize this cohort including risk for subsequent cardiovascular events are planned.