{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T17:22:19Z","timestamp":1792516939073,"version":"4.5.0"},"reference-count":31,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2017,9,22]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      Radiation therapy (\n                      <jats:styled-content style=\"fixed-case\">RT<\/jats:styled-content>\n                      ) is a standard treatment for head and neck cancer; however, it is associated with inflammation, accelerated atherosclerosis, and cerebrovascular events (\n                      <jats:styled-content style=\"fixed-case\">CVEs<\/jats:styled-content>\n                      ; stroke or transient ischemic attack). Human papillomavirus (\n                      <jats:styled-content style=\"fixed-case\">HPV<\/jats:styled-content>\n                      ) is found in nearly half of head and neck cancers and is associated with inflammation and atherosclerosis. Whether\n                      <jats:styled-content style=\"fixed-case\">HPV<\/jats:styled-content>\n                      confers an increased risk of\n                      <jats:styled-content style=\"fixed-case\">CVE<\/jats:styled-content>\n                      s after\n                      <jats:styled-content style=\"fixed-case\">RT<\/jats:styled-content>\n                      is unknown.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      Using an institutional database, we identified all consecutive patients treated with\n                      <jats:styled-content style=\"fixed-case\">RT<\/jats:styled-content>\n                      from 2002 to 2012 for head and neck cancer who were tested for\n                      <jats:styled-content style=\"fixed-case\">HPV<\/jats:styled-content>\n                      . The outcome of interest was the composite of ischemic stroke and transient ischemic attack, and the association between\n                      <jats:styled-content style=\"fixed-case\">HPV<\/jats:styled-content>\n                      and\n                      <jats:styled-content style=\"fixed-case\">CVE<\/jats:styled-content>\n                      s was assessed using Cox proportional hazard models, competing risk analysis, and inverse probability weighting. Overall, 326 participants who underwent\n                      <jats:styled-content style=\"fixed-case\">RT<\/jats:styled-content>\n                      for head and neck cancer were tested for\n                      <jats:styled-content style=\"fixed-case\">HPV<\/jats:styled-content>\n                      (age 59\u00b112\u00a0years, 75% were male, 9% had diabetes mellitus, 45% had hypertension, and 61% were smokers), of which 191 (59%) were tumor HPV positive. Traditional risk factors for\n                      <jats:styled-content style=\"fixed-case\">CVEs<\/jats:styled-content>\n                      were similar between HPV\u2010positive and \u2010negative patients. Over a median follow\u2010up of 3.4\u00a0years, there were 18 ischemic strokes and 5 transient ischemic attacks (event rate of 1.8% per year). The annual event rate was higher in the\n                      <jats:styled-content style=\"fixed-case\">HPV<\/jats:styled-content>\n                      \u2010positive patients compared with the HPV\u2010negative patients (2.6% versus 0.9%,\n                      <jats:italic>P<\/jats:italic>\n                      =0.002). In a multivariable model, HPV\u2010positive status was associated with a &gt;4 times increased risk of\n                      <jats:styled-content style=\"fixed-case\">CVEs<\/jats:styled-content>\n                      (hazard ratio: 4.4; 95% confidence interval, 1.5\u201313.2;\n                      <jats:italic>P<\/jats:italic>\n                      =0.008).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">In this study, HPV\u2010positive status is associated with an increased risk of stroke or transient ischemic attack following RT for head and neck cancer.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.117.006453","type":"journal-article","created":{"date-parts":[[2017,8,30]],"date-time":"2017-08-30T20:10:38Z","timestamp":1504123838000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":37,"title":["Human Papillomavirus Status and the Risk of Cerebrovascular Events Following Radiation Therapy for Head and Neck Cancer"],"prefix":"10.1161","volume":"6","author":[{"given":"Daniel","family":"Addison","sequence":"first","affiliation":[{"name":"Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA"},{"name":"Cardio\u2010Oncology Program, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara B.","family":"Seidelmann","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of 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R.","family":"Hallett","sequence":"additional","affiliation":[{"name":"Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B\u00e1lint","family":"Szilveszter","sequence":"additional","affiliation":[{"name":"Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael T.","family":"Lu","sequence":"additional","affiliation":[{"name":"Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard P.","family":"Cambria","sequence":"additional","affiliation":[{"name":"Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, 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National Comprehensive Cancer Network Guidelines. Head and neck cancer guidelines. Available at: http:\/\/www.sld.cu\/galerias\/pdf\/sitios\/cirugiamaxilo\/nccn-head-and-neck.pdf. 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