Supplemental Table 1. Sociodemographic, clinical data and therapeutic exposures available in BMT Survivor Study.

Variable	Source of Information	Details of analytic variables	
Sociodemographics	BMTSS survey	Age at completion of survey, sex, race/ethnicity, income, education, health insurance	
Health Behaviors	BMTSS survey	Smoking, alcohol, physical activity	
Primary cancer characteristics	Medical record abstraction	Diagnosis, relevant biologic characteristics, age at BMT,	

Pre-BMT exposures	

Medical record abstraction	Radiation therapy: radiation dosimetry to calculate organ-specific radiation dose
Chemotherapy: agents, cumulative dose for select agents (anthracyclines, alkylators, topoisomerase II inhibitors, platinum, bleomycin)
Other biologic agents (targeted therapy): agents	

BMT related variables	

Medical record abstraction	Donor type: unrelated (degree of match), related (matched, mismatched)
Stem cell source: bone marrow, peripheral blood stem cells, cord blood (single/ double)
Conditioning regimens: agents, dose
Conditioning Intensity: Reduced intensity/ non-myeloablative/ myeloablative	

Comorbidities	

BMTSS survey	Pre-BMT and post-BMT new onset comorbidities: CVRFs (hypertension, diabetes, dyslipidemia, obesity), coronary heart disease, chronic kidney disease, venous thromboembolism, stroke, arrhythmia
Chronic GvHD: age of onset, organs involved	

Abbreviations: BMT, blood or marrow transplant; BMTSS, blood or marrow transplant survivor study; CVRFs, cardiovascular risk factors; GvHD, graft vs host disease.
   Supplemental Table 2. Characteristics of the BMT survivor study participants compared to non-participants.
Variable	Participants (6,677)	   Non participants (2,243)	p value	
Age at BMT in Years (Mean, standard deviation)	42	19.3	33.3	20.7	<0.001	
Male Sex (n, %)	3891	58.27	1341	59.79	0.21	
Race/ ethnicity (n, %)	
Non-Hispanic White	4897	73.34	1389	61.93	

<0.001	
Hispanic	847	12.69	395	17.61		
Black	442	6.62	223	9.94		
Asian	339	5.08	198	8.83		
Other	152	2.28	38	1.69		
BMT Type (n, %)	
Allogeneic	3232	48.4	1240	55.28	<0.001	
Autologous	3445	51.6	1003	44.72		
Primary malignancy (n, %)	
Acute lymphoblastic leukemia	604	9.05	236	10.52	

<0.001	
Acute myeloid leukemia/ Myelodysplasia	1420	21.27	450	20.06		
Chronic myelogenous leukemia	586	8.78	142	6.33		
Non Hodgkin lymphoma	1544	23.12	439	19.57		
Hodgkin lymphoma	492	7.37	227	10.12		
Plasma cell dyscrasias	1326	19.86	305	13.6		
Severe aplastic anemia	178	2.67	120	5.35		
Other/ Missing	455	6.81	313	13.96		
BMT Era (n, %)	
<1990	640	9.59	88	3.92	
<0.001	
1990-1999	1692	25.34	334	14.89		
2000-2009	2664	39.9	886	39.5		
2010+	1681	25.18	935	41.69		
  Abbreviations: BMT, blood or marrow transplant.

Supplemental Table 3. Risk of coronary heart disease in BMT survivors compared to sibling cohort.
Variable	Univariable analysis	Multivariable analysis	
	OR	95% CI	p value	OR	95% CI	p value	
Cohort	
BMT cohort vs siblings	1.33	0.91-1.96	0.140	1.61	1.09-2.40	0.018	
Age at BMTSS participation	1.06	1.05-1.08	<0.001	1.06	1.04-1.07	<0.001	
Sex	
Male vs Female	1.85	1.32-2.57	<0.001	1.62	1.15-2.27	0.005	
Race/Ethnicity	
Non-Hispanic Whites vs Others	1.59	1.03-2.45	0.034	1.50	0.95-2.37	0.079	
Education (Ref: College Graduate)	
Some college	0.85	0.55-1.31	0.47	_	_	_	
≤High School	0.94	0.63-1.42	0.79	_	_	_	
Household Income (Ref: >$20-000/year)	
≤$20-000	1.06	0.63-1.77	0.84	_	_	_	
Missing	1.00	0.62-1.59	0.99	_	_	_	
Comorbidities (Yes vs No)	
Obesity (Body mass index)	1.03	1.01-1.06	0.017	_	_	_	
Diabetes	1.57	1.06-2.35	0.026	_	_	_	
Hypertension	1.44	1.05-1.97	0.024	_	_	_	
Dyslipidemia	1.87	1.36-2.55	<0.001	_	_	_	
Chronic kidney disease	1.05	0.53-2.09	0.88	_	_	_	
Venous thromboembolism	0.49	0.23-1.04	0.065	0.38	0.18-0.83	0.015	
Arrhythmia	1.11	0.68-1.81	0.67	_	_	_	
Stroke	1.14	0.50-2.61	0.76	_	_	_	
Health Behaviors (Yes vs No)	
Alcohol intake	0.70	0.52-0.96	0.028	_	_	_	
Smoking	0.33	0.22-0.52	<0.001	_	_	_	

Abbreviations: BMT, blood or marrow transplant; BMTSS, BMT survivor study; CI, confidence interval; OR, odds ratio. “_” signifies that the variable was not retained in the multivariable model.

Supplemental Table 4. Demographic and clinical characteristics of BMT survivors, overall and by type of BMT.
Variable	All patients (n=6,677)	Autologous (n=3,445)	Allogeneic (n=3,232)	p value (autologous vs allogeneic)	
Coronary Heart Disease	
N (%)	249 (3.73%)	141 (4.09%)	108 (3.34%)	<0.001	
Alive at study participation	
N (%)	3746 (56.10%)	1733 (50.30%)	2013 (62.28%)	<0.001	
Age at BMT	
Mean (SD)	43.94 (17.70)	49.74 (15.04)	37.67 (18.12)	<0.001	
Sex (n, %)	
Male	3891 (58.27%)	2033 (59.01%)	1858 (57.49%)	0.21	
Race/Ethnicity (n, %)	
Non-Hispanic Whites	4897 (73.34%)	2535 (73.58%)	2362 (73.08%)	

<0.001	
Hispanic	847 (12.69%)	372 (10.80%)	475 (14.70%)		
Black	442 (6.62%)	333 (9.67%)	109 (3.37%)		
Asian	339 (5.08%)	135 (3.92%)	204 (6.31%)		
Other	152 (2.28%)	70 (2.03%)	82 (2.54%)		
Stem cell source (n, %)	
Cord Blood	370 (5.54%)	1 (0.03%)	369 (11.42%)	
<0.001	
Peripheral Blood Stem Cells	4425 (66.27%)	3127 (90.77%)	1298 (40.16%)		
Bone Marrow	1882 (28.19%)	317 (9.20%)	1565 (48.42%)		
Disease status (n, %)	
Standard risk	3057 (45.78%)	2044 (59.33%)	1013 (31.34%)	
<0.001	
High risk	2571 (38.51%)	1021 (29.64%)	1550 (47.96%)		
Missing	1049 (15.71%)	380 (11.03%)	669 (20.70%)		
Primary Cancer Diagnosis (n, %)	

Variable	All patients (n=6,677)	Autologous (n=3,445)	Allogeneic (n=3,232)	p value (autologous vs allogeneic)	
Acute lymphoblastic leukemia	604 (9.05%)	51 (1.48%)	553 (17.11%)	

<0.001	
Acute myeloid leukemia/ Myelodysplasia	1420 (21.27%)	212 (6.15%)	1208 (37.38%)		
Chronic myelogenous leukemia	586 (8.78%)	60 (1.74%)	526 (16.27%)		
Non Hodgkin lymphoma	1544 (23.12%)	1233 (35.79%)	311 (9.62%)		
Hodgkin lymphoma	492 (7.37%)	463 (13.44%)	29 (0.9%)		
Plasma cell dyscrasias	1326 (19.86%)	1277 (37.07%)	49 (1.52%)		
Severe aplastic anemia	178 (2.67%)	1 (0.03%)	177 (5.48%)		
Other	526 (7.88%)	148 (4.3%)	378 (11.7%)		
Missing	1 (0.01%)	0 (0.00%)	1 (0.03%)		
Conditioning regimens intensity (n, %)	
Myeloablative	5156 (77.22)	3310 (96.08%)	1846 (57.12%)	<0.001	
Non-myeloablative or Reduced intensity	1468 (21.98)	91 (2.64%)	1377 (42.60%)		
Missing/ Other	53 (0.79)	44 (1.28)	9 (0.27)		
Total Body Irradiation (n, %)a	
Yes	3020 (45.39)	977 (28.39%)	2043 (63.61%)	<0.001	
Pre-BMT chemotherapy (n, %)	b	
Alkylators	2189 (47.54%)	1558 (63.15%)	631 (29.51%)	<0.001	
Anthracyclines	3075 (66.78%)	1717 (69.60%)	1358 (63.52%)	<0.001	
Antimetabolite	2084 (45.26%)	787 (31.90%)	1297 (60.66%)	<0.001	
Asparaginase	313 (6.80%)	17 (0.69%)	296 (13.84%)	<0.001	
Bleomycin	427 (9.27%)	404 (16.38%)	23 (1.08%)	<0.001	
Hydroxyurea	576 (12.51%)	60 (2.43%)	516 (24.13%)	<0.001	
Hypomethylating agents	150 (3.26%)	2 (0.08%)	148 (6.92%)	<0.001	
Immunosuppression	64 (1.39%)	2 (0.08%)	62 (2.90%)	<0.001	

Variable	All patients (n=6,677)	Autologous (n=3,445)	Allogeneic (n=3,232)	p value (autologous vs allogeneic)	
Platinum agents	868 (18.85%)	734 (29.75%)	134 (6.27%)	<0.001	
Purine Nucleoside Analogs	275 (5.97%)	53 (2.15%)	222 (10.38%)	<0.001	
Plant Alkaloid	2190 (47.56%)	1507 (61.09%)	683 (31.95%)	<0.001	
Corticosteroids	2873 (62.39%)	2038 (82.61%)	835 (39.06%)	<0.001	
Targeted therapiesc	1364 (29.62%)	946 (38.35%)	418 (19.55%)	<0.001	
Thalidomide	576 (12.51%)	532 (21.56%)	44 (2.06%)	<0.001	
Topoisomerase inhibitors	1217 (26.43%)	847 (34.33%)	370 (17.31%)	<0.001	
Monoclonal Antibodies	890 (19.33%)	649 (26.31%)	241 (11.27%)	<0.001	
Antithymocyte globulin	43 (0.93%)	0 (0.00%)	43 (2.01%)	<0.001	
Interferon	190 (4.13%)	42 (1.70%)	148 (6.92%)	<0.001	
Pre-BMT radiation (n, %)	
Any radiation	772 (16.76%)	589 (23.88%)	183 (8.60%)	<0.001	
Chest radiation (Yes vs No)	216 (4.69%)	197 (7.99%)	19 (0.89%)	<0.001	
Neck radiation (Yes vs No)	125 (2.71%)	112 (4.54%)	13 (0.61%)	<0.001	
Chronic graft vs host disease (n, %)	
Yes	1795 (26.88%)	NA	1795 (55.54%)	_	
Abbreviations: BMT, blood or marrow transplant; SD, standard deviation; NA, not applicable.
a Total body irradiation information was missing for 24 participants (4 autologous and 20 allogeneic BMT recipients)
b Pre-BMT treatment information was missing in 2072 participants (978 autologous and 1094 allogeneic BMT recipients)
c Targeted therapies included tyrosine kinase inhibitors, proteasome inhibitors, histone deacetylase inhibitors, JAK2 inhibitors etc.

Supplemental Table 5. Risk factors associated with coronary heart disease in allogeneic BMT recipients including alive and deceased patients.
Category	Univariable Analysis	Multivariable Analysis	Parsimonious model a (p<0.1 in multivariable model)	
	HR	95% CI	p value	HR	95% CI	p value	HR	95% CI	p value	
Age at BMT	
Per year increase in age	1.04	1.03-1.05	<0.001	1.04	1.02-1.05	<0.001	1.04	1.03-1.05	<0.001	
Sex ( ref: Female)	
Male	1.90	1.25-2.89	0.003	1.84	1.20-2.81	0.005	1.80	1.18-2.74	0.006	
Race (ref: Other)	
Non-Hispanic White individuals	1.65	1.01-2.71	0.047	1.54	0.94-2.53	0.088	1.55	0.94-2.54	0.084	
Primary Diagnosis (ref: Acute lymphoblastic leukemia)	
Acute myeloid leukemia/Myelodysplastic syndrome	

2.93	

1.39-6.20	

0.005	

1.40	

0.63-3.11	

0.40	

_	

_	

_	
Chronic myelogenous leukemia	3.13	1.44-6.83	0.004	1.57	0.67-3.70	0.30	_	_	_	
Non-Hodgkin lymphoma	4.05	1.72-9.52	0.001	1.61	0.66-3.93	0.30	_	_	_	
Severe aplastic anemia	1.52	0.50-4.60	0.46	1.78	0.48-6.69	0.39	_	_	_	
Other	1.17	0.44-3.12	0.75	1.07	0.38-3.02	0.91	_	_	_	
Stem Cell Source (ref: bone marrow)	
Peripheral blood stem cells	1.81	1.25-2.63	0.002	0.71	0.41-1.24	0.23	_	_	_	
Cord	1.03	0.50-2.15	0.93	0.69	0.32-1.51	0.36	_	_	_	
Disease risk status at BMT (ref: standard risk)	
High Risk	1.32	0.88-1.99	0.18	1.13	0.73-1.76	0.59	_	_	_	
Missing	0.48	0.27-0.83	0.009	0.94	0.49-1.82	0.86	_	_	_	
Chronic Graft vs Host Disease	
Yes vs No	1.69	1.12-2.55	0.013	1.07	0.69-1.65	0.76	_	_	_	
Missing	2.24	1.04-4.82	0.038	1.43	0.66-3.06	0.36	_	_	_	
Conditioning regimen (ref: Non-myeloablative conditioning + Reduced intensity conditioning)	
Myeloablative conditioning	0.74	0.51-1.07	0.11	_	_	_	_	_	_	

Total body irradiation	
Yes vs No	0.73	0.50-1.07	0.011	0.97	0.86-1.10	0.61				
Pre-BMT chemotherapy	
Alkylators	0.89	0.54-1.46	0.63	_	_	_	_	_	_	
Anthracyclines	0.86	0.56-1.31	0.48	_	_	_	_	_	_	
Antimetabolite	0.79	0.51-1.20	0.26	_	_	_	_	_	_	
Asparaginase	0.20	0.06-0.64	0.007	0.55	0.16-1.91	0.35	_	_	_	
Bleomycin	3.21	1.04-9.95	0.043	_	_	_	_	_	_	
Hydroxyurea	1.12	0.71-1.78	0.62	_	_	_	_	_	_	
Monoclonal Antibodies	0.91	0.40-2.10	0.83	_	_	_	_	_	_	
Plant Alkaloid	0.80	0.50-1.29	0.36	_	_	_	_	_	_	
Platinum agents	1.05	0.38-2.86	0.93	_	_	_	_	_	_	
Corticosteroids	0.91	0.58-1.42	0.68	_	_	_	_	_	_	
Targeted therapiesb	1.27	0.73-2.19	0.40	_	_	_	_	_	_	
Thalidomide	3.64	1.33-9.99	0.012	_	_	_	_	_	_	
Topoisomerase inhibitors	0.83	0.44-1.56	0.56	_	_	_	_	_	_	
Pre-BMT radiation	
Any radiation	0.42	0.15-1.13	0.085	_	_	_	_	_	_	
Chest radiation- Yes vs No	2.39	0.63-9.04	0.20	_	_	_	_	_	_	
Neck radiation- Yes vs No	3.59	1.00-12.95	0.051	_	_	_	_	_	_	

Abbreviations: BMT, blood or marrow transplant; HR, Hazard ratio; CI, Confidence interval.
a Parsimonious model was obtained using backward variable selection, keeping variables with p<0.1 in the model.
b Targeted therapies included tyrosine kinase inhibitors, proteasome inhibitors, histone deacetylase inhibitors, JAK2 inhibitors etc. “_” signifies that the variable was not retained in the multivariable and/or parsimonious model.

Supplemental Table 6. Risk factors associated with coronary heart disease in autologous BMT recipients including alive and deceased patients.
Category	Univariable Analysis	Multivariable Analysis a	
	HR	95% CI	p value	HR	95% CI	p value	
Age at BMT	
Per year increase in age	1.03	1.02-1.04	<0.001	1.04	1.02-1.05	<0.001	
Sex (ref: Female)	
Male	1.73	1.20-2.48	0.003	1.64	1.14-2.35	0.007	
Race (ref: Other)	
Non-Hispanic White individuals	0.97	0.67-1.41	0.88	_	_	_	
Primary Diagnosis ( ref: Acute myeloid leukemia/Myelodysplastic syndrome)	
Hodgkin lymphoma	1.53	0.69-3.39	0.29	_	_	_	
Non-Hodgkin lymphoma	1.44	0.69-3.02	0.33	_	_	_	
Plasma cell dyscrasias	1.43	0.68-2.99	0.35	_	_	_	
Other	0.66	0.23-1.9	0.44	_	_	_	
Stem Cell Source (ref: bone marrow)	
Peripheral blood stem cells	1.45	0.83-2.53	0.20	_	_	_	
Disease risk status at BMT (ref: standard risk)	
High Risk	0.90	0.62-1.28	0.55	_	_	_	
Missing	0.67	0.37-1.21	0.18	_	_	_	
Conditioning regimen (ref: Myeloablative conditioning)	
Reduced intensity conditioning	0.46	0.12- 1.82	0.27	_	_	_	
Total body irradiation	
Yes vs No	0.76	0.53-1.10	0.15	_	_	_	
Pre-BMT chemotherapy	
Alkylators	0.98	0.66-1.47	0.94	_	_	_	
Anthracyclines	0.92	0.59-1.43	0.71	_	_	_	
Antimetabolite	0.63	0.41-0.96	0.030	_	_	_	
Asparaginase	0.66	0.09-4.69	0.68	_	_	_	
Bleomycin	0.92	0.57-1.48	0.73	_	_	_	

Hydroxyurea	1.04	0.33-3.28	0.94	_	_	_	
Monoclonal Antibodies	1.29	0.83-2.00	0.26	_	_	_	
Plant Alkaloid	1.03	0.69-1.54	0.89	_	_	_	
Platinum agents	0.88	0.57-1.36	0.57	_	_	_	
Corticosteroids	1.17	0.71-1.95	0.53	_	_	_	
Targeted therapies b	1.41	0.95-2.08	0.088	_	_	_	
Thalidomide	1.32	0.82-2.12	0.25	_	_	_	
Topoisomerase inhibitors	0.82	0.54-1.23	0.34	_	_	_	
Pre-BMT radiation	
Any radiation	1.48	0.99-2.21	0.056	_	_	_	
Chest radiation- Yes vs No	1.91	1.14-3.20	0.013	2.92	1.73-4.92	<0.001	
Neck radiation- Yes vs No	0.82	0.30-2.21	0.69	_	_	_	

Abbreviations: BMT, blood or marrow transplant; HR, Hazard ratio; CI, Confidence interval.
a Parsimonious model was obtained using backward variable selection, keeping variables with p<0.1 in the model.
b Targeted therapies included tyrosine kinase inhibitors, proteasome inhibitors, histone deacetylase inhibitors, JAK2 inhibitors etc. “_” signifies that the variable was not retained in the multivariable model.

Supplemental Table 7. Risk factors associated with coronary heart disease in allogeneic BMT survivors who were alive at BMTSS survey.
Category	Univariable Analysis	Multivariable Analysis	Parsimonious model a
(p<0.1 in multivariable model)	
	HR	95% CI	p value	HR	95% CI	p value	HR	95% CI	p value	
Age at BMT	
Per year increase in age	1.07	1.04-1.09	<0.001	1.04	1.01-1.07	0.008	1.04	1.02-1.06	<0.001	
Sex (ref: Female)	
Male	1.80	1.01-3.19	0.045	1.71	0.93-3.15	0.086	1.84	1.04-3.38	0.037	
Race/ethnicity (ref: Other)	
Non-Hispanic Whites	2.44	1.04-5.69	0.040	2.24	0.93-5.39	0.073	2.43	1.04-5.70	0.041	
Education (ref: College graduate)	
Some college	0.62	0.33-1.16	0.14	_	_	_	_	_	_	
≤High School	0.74	0.38-1.46	0.39	_	_	_	_	_	_	
Income (ref: ≥$20k)	
<$20k	0.62	0.24-1.55	0.30	_	_	_	_	_	_	
Missing	0.71	0.30-1.66	0.43	_	_	_	_	_	_	
Smoking	
Current or past smoking- Yes vs No	2.19	1.27-3.76	0.005	1.12	0.62-2.01	0.71	_	_	_	
Alcohol use	
Current or past alcohol use- Yes vs No	1.86	1.07-3.23	0.028	1.37	0.76-2.46	0.30	_	_	_	
Comorbidities	
Diabetes	4.22	2.35-7.57	<0.001	1.91	1.00-3.64	0.049	1.89	1.02-3.48	0.042	
Obesity (Body mass index)	1.04	1.01-1.08	0.021	_	_	_	_	_	_	
Hypertension	6.70	3.76-11.95	<0.001	3.32	1.76-6.27	0.0002	3.25	1.74-6.06	0.0002	
Dyslipidemia	5.35	3.11-9.22	<0.001	1.73	0.93-3.23	0.085	1.78	0.97-3.28	0.065	
Chronic kidney disease	1.78	0.55-5.70	0.33	_	_	_				
Arrhythmia	1.37	0.55-3.45	0.50	_	_	_	_	_	_	

Venous thromboembolism	1.13	0.35-3.64	0.84	_	_	_	_	_	_	
Stroke	NA	NA	NA	_	_	_	_	_	_	
Chronic graft vs host disease	1.98	1.14-3.41	0.015	1.01	0.56-1.81	0.98	_	_	_	
Relapse of primary cancer/ secondary malignancy	
2.03	
0.99-4.17	
0.053	
0.87	
0.41-1.82	
0.71	_	_	_	
Primary Diagnosis (ref: Acute lymphoblastic leukemia)	
Acute myeloid leukemia/Myelodysplastic syndrome	
2.84	
0.84-9.60	
0.094	
1.81	
0.39-8.49	
0.45	_	_	_	
Chronic myelogenous leukemia	2.91	0.83-10.16	0.095	1.69	0.33-8.66	0.53	_	_	_	
Non-Hodgkin lymphoma	2.40	0.57-10.10	0.23	1.20	0.21-6.76	0.83	_	_	_	
Severe aplastic anemia	1.05	0.17-6.30	0.96	2.78	0.29-26.39	0.37	_	_	_	
Other	3.04	0.82-11.30	0.096	2.22	0.36-13.66	0.39	_	_	_	
Stem Cell Source (ref: bone marrow)	
Peripheral blood stem cells	3.23	1.70-6.13	<0.001	1.13	0.48-2.65	0.78	_	_	_	
Cord	0.96	0.28-3.27	0.95	0.61	0.14-2.63	0.51	_	_	_	
Disease risk status at BMT (ref: standard risk)	
High risk	1.65	0.92-2.95	0.092	1.06	0.54-2.08	0.86	_	_	_	
Missing	0.51	0.23-1.13	0.097	0.95	0.35-2.59	0.91	_	_	_	
Conditioning regimen (ref: non-myeloablative or reduced intensity conditioning)	
Myeloablative conditioning	0.76	0.43-1.33	0.33	_	_	_	_	_	_	
Total body irradiation	
Yes vs No	0.74	0.43-1.29	0.29	_	_	_	_	_	_	
Pre-BMT chemotherapy	
Alkylators	0.91	0.48-1.72	0.78	_	_	_	_	_	_	
Anthracyclines	0.78	0.45-1.37	0.39	_	_	_	_	_	_	
Antimetabolite	0.90	0.51-1.57	0.70	_	_	_	_	_	_	
Asparaginase	0.20	0.05-0.84	0.028	0.91	0.14-5.90	0.92	_	_	_	
Bleomycin	5.73	1.78-18.46	0.003	_	_	_	_	_	_	
Hydroxyurea	1.23	0.67-2.26	0.51	_	_	_	_	_	_	

Monoclonal Antibodies	0.72	0.22-2.35	0.59	_	_	_	_	_	_	
Plant Alkaloids	0.83	0.45-1.52	0.54	_	_	_	_	_	_	
Platinum agents	1.57	0.56-4.39	0.39	_	_	_	_	_	_	
Corticosteroids	0.73	0.41-1.31	0.30	_	_	_	_	_	_	
Targeted therapies b	1.38	0.64-3.00	0.41	_	_	_	_	_	_	
Thalidomide	6.02	1.42-25.48	0.015	_	_	_	_	_	_	
Topoisomerase inhibitors	0.80	0.36-1.78	0.58	_	_	_	_	_	_	
Pre-BMT radiation	
Any radiation	0.17	0.02-1.24	0.081	_	_	_	_	_	_	
Chest radiation (Yes vs No)	2.14	0.30-15.51	0.45	_	_	_	_	_	_	
Neck radiation (Yes vs No)	3.22	0.44-23.38	0.25	_	_	_	_	_	_	

Abbreviations: BMT, blood or marrow transplant; BMTSS, blood or marrow transplant survivor study; HR, Hazard ratio; CI, Confidence interval; NA, numbers too low to analyze.
a Parsimonious model was obtained using backward variable selection, keeping variables with p<0.1 in the model.
b Targeted therapies included tyrosine kinase inhibitors, proteasome inhibitors, histone deacetylase inhibitors, JAK2 inhibitors etc. “_” signifies that the variable was not retained in the multivariable and/or parsimonious model.

Supplemental Table 8. Risk factors associated with coronary heart disease in autologous BMT survivors who were alive at BMTSS survey.
Category	Univariable Analysis	Multivariable Analysis	Parsimonious model a
(p<0.1 in multivariable model)	
	HR	95% CI	p value	HR	95% CI	p value	HR	95% CI	p value	
Age at BMT	
Per year increase in age	1.05	1.03-1.07	<0.001	1.04	1.02-1.06	0.001	1.05	1.02-1.07	<0.001	
Sex (ref: Female)	
Male	2.25	1.35-3.75	0.002	1.94	1.15-3.25	0.012	1.85	1.11-3.10	0.019	
Race (ref: Other)	
Non-Hispanic White individuals	0.86	0.50-1.46	0.57	_	_	_	_	_	_	
Education (ref: College Graduate)	
Some college	1.14	0.68-1.91	0.61	_	_	_	_	_	_	
≤High School	1.26	0.70-2.26	0.44	_	_	_	_	_	_	
Income (ref: ≥$20k)	
<$20k	1.10	0.55-2.23	0.78	_	_	_	_	_	_	
Missing	0.82	0.39-1.72	0.60	_	_	_	_	_	_	
Smoking	
Current or past smoking- Yes vs No	2.43	1.54-3.83	<0.001	1.80	1.13-2.87	0.014	1.78	1.12-2.84	0.020	
Alcohol use	
Current or past alcohol use- Yes vs No	1.00	0.64-1.58	0.99	_	_	_	_	_	_	
Comorbidities	
Diabetes	2.90	1.67-5.04	<0.001	1.60	0.88-2.91	0.126	1.71	0.95-3.06	0.074	
Obesity (Body mass index)	1.00	0.96-1.05	0.86	_	_	_	_	_	_	
Hypertension	1.97	1.24-3.12	0.004	0.88	0.52-1.48	0.624	_	_	_	
Dyslipidemia	3.03	1.93-4.77	<0.001	1.66	0.99-2.78	0.054	1.69	1.02-2.79	0.040	
Chronic kidney disease	1.77	0.71-4.39	0.22	_	_	_	_	_	_	
Arrhythmia	2.40	1.32-4.38	0.004	1.68	0.90-3.14	0.105	_	_	_	

Venous thromboembolism	1.13	0.49-2.61	0.77	_	_	_	_	_	_	
Stroke	3.70	1.60-8.58	0.002	2.55	1.06-6.13	0.036	2.52	1.06-5.96	0.036	
Relapse of primary cancer/ secondary malignancy	
1.63	
0.82-3.24	
0.17	_	_	_	_	_	_	
Primary Diagnosis (ref: Acute myeloid leukemia/Myelodysplastic syndrome)	
Hodgkin lymphoma	1.68	0.59-4.79	0.33	_	_	_	_	_	_	
Non-Hodgkin lymphoma	1.59	0.61-4.17	0.35	_	_	_	_	_	_	
Plasma cell dyscrasias	2.22	0.81-6.03	0.12	_	_	_	_	_	_	
Other	1.05	0.28-3.92	0.94	_	_	_	_	_	_	
Stem Cell Source (ref: bone marrow)	
Peripheral blood stem cells	3.63	1.41-9.35	0.007	2.18	0.79-5.98	0.130	_	_	_	
Disease risk status at BMT (ref: standard risk)	
High Risk	1.03	0.64-1.66	0.91	_	_	_	_	_	_	
Missing	0.59	0.24-1.42	0.23	_	_	_	_	_	_	
Conditioning regimen (ref: non-myeloablative or reduced intensity conditioning)	
Myelo-ablative conditioning	2.88	0.40-20.81	0.30	_	_	_	_	_	_	
Total body irradiation	
Yes vs No	0.68	0.41-1.10	0.12	_	_	_	_	_	_	
Pre-BMT chemotherapy	
Alkylators	1.07	0.65-1.76	0.80	_	_	_	_	_	_	
Anthracyclines	0.87	0.49-1.55	0.63	_	_	_	_	_	_	
Antimetabolite	0.53	0.32-0.89	0.016	0.74	0.42-1.29	0.285	_	_	_	
Asparaginase	0.62	0.09-4.53	0.64	_	_	_	_	_	_	
Bleomycin	0.72	0.39-1.33	0.29	_	_	_	_	_	_	
Hydroxyurea	NA	NA	NA	_	_	_	_	_	_	
Monoclonal Antibodies	1.56	0.92-2.63	0.099	1.09	0.63-1.86	0.765	_	_	_	
Plant Alkaloid	1.04	0.63-1.70	0.89	_	_	_	_	_	_	
Platinum agents	1.01	0.61-1.67	0.97	_	_	_	_	_	_	
Corticosteroids	1.57	0.83-3.00	0.17	_	_	_	_	_	_	
Targeted therapies b	1.87	1.12-3.12	0.017	1.36	0.78-2.35	0.275	_	_	_	

Thalidomide	1.44	0.77-2.70	0.26	_	_	_	_	_	_	
Topoisomerase inhibitors	0.93	0.57-1.50	0.75	_	_	_	_	_	_	
Pre-BMT radiation	
Any radiation	1.53	0.93-2.50	0.095	_	_	_	_	_	_	
Chest radiation (Yes vs No)	1.64	0.84-3.20	0.15	2.73	1.33-5.60	0.006	3.04	1.50-6.17	0.002	
Neck radiation (Yes vs No)	1.28	0.47-3.52	0.63	_	_	_	_	_	_	

Abbreviations: BMT, blood or marrow transplant; BMTSS, blood or marrow transplant survivor study; CI, Confidence interval; HR, Hazard ratio.
a Parsimonious model was obtained using backward variable selection, keeping variables with p<0.1 in the model.
b Targeted therapies included tyrosine kinase inhibitors, proteasome inhibitors, histone deacetylase inhibitors, JAK2 inhibitors etc. “_” signifies that the variable was not retained in the multivariable and/or parsimonious model.

Supplemental Table 9. Impact of pre-BMT and post-BMT cardiovascular risk factors on coronary heart disease risk in alive BMT survivors.a

Cohort	
Parameter	Hazard Ratio	95% Confidence Intervals	
p value	
All alive participants	Pre-BMT cardiovascular risk factors	3.66	2.48-5.39	<0.0001	
	Cardiovascular risk factors that develop after BMT	2.02	1.33-3.07	0.0009	
Allogeneic BMT recipients	Pre-BMT cardiovascular risk factors	3.51	1.90-6.48	<0.0001	
	Cardiovascular risk factors that develop after BMT	3.56	1.95-6.48	<0.0001	
Autologous BMT recipients	Pre-BMT cardiovascular risk factors	3.57	2.15-5.91	<0.0001	
	Cardiovascular risk factors that develop after BMT	1.25	0.66-2.39	0.494	
Abbreviations: BMT, blood or marrow transplant.
a Pre-BMT cardiovascular risk factors (hypertension, diabetes, dyslipidemia) were assessed as presence of these conditions at the time of BMT (yes vs no), and post BMT risk factors included new development of these comorbidities which were analyzed as time varying covariates.

Supplemental Table 10. Risk prediction model for CHD in BMT survivors.
Variable	Estimation	Standard Error	Hazard Ratio	95% Confidence Intervals	p value	
Age at BMT, per year increase in age	0.0567	0.0101	1.06	1.04-1.08	<0.001	
Sex, male	0.6354	0.2548	1.89	1.15-3.11	0.013	
Smoking, yes vs no	0.4787	0.2401	1.61	1.01-2.58	0.046	
Diabetes	0.8959	0.3531	2.45	1.23-4.89	0.011	
Hypertension	0.7014	0.2870	2.02	1.15-3.54	0.015	
Arrhythmia	0.6418	0.3876	1.90	0.89-4.06	0.098	
Pre-BMT chest radiation, Yes	1.0390	0.4378	2.83	1.20-6.67	0.018	
Pre-BMT chest radiation, Unknown	-0.1231	0.4822	0.88	0.34-2.28	0.80	
Abbreviations: BMT, blood or marrow transplant; CHD, coronary heart disease.

Supplement Figure 1. Consort diagram showing BMT recipients included in the study. The study included patients that survived ≥2 years after BMT and were alive and completed BMTSS and those that were deceased. Abbreviations: BMT, Blood or marrow transplantation; BMTSS, Blood or marrow transplantation Survivor Study.

Supplement Figure 2. Cumulative incidence of CHD in the entire cohort and by BMT type. Panel A shows the cumulative incidence of CHD in all study participants and panel B shows the cumulative incidence in allogeneic (blue) and autologous (orange) BMT recipients. Abbreviations: BMT, blood or marrow transplantation; CHD, coronary heart disease.

Supplement Figure 3. Cumulative incidence of CHD in alive BMT survivors. Panel A shows the cumulative incidence of CHD in all alive study participants and panel B shows the cumulative incidence in alive allogeneic (blue) and autologous (orange) BMT recipients. Abbreviations: BMT, blood or marrow transplantation; CHD, coronary heart disease.