Exercise and risk of major cardiovascular events in adult survivors of childhood Hodgkin lymphoma

A report from the childhood cancer survivor study

Lee W. Jones, Qi Liu, Gregory Armstrong, Kirsten K. Ness, Yutaka Yasui, Katie Devine, Emily Tonorezos, Luisa Soares-Miranda, Charles A. Sklar, Pamela S. Douglas, Leslie L. Robison, Kevin C. Oeffinger

Research output: Contribution to journalArticle

57 Citations (Scopus)

Abstract

Purpose: Survivors of Hodgkin lymphoma (HL) are at increased risk of treatment-related cardiovascular (CV) events; whether exercise modifies this risk is unknown.

Methods: Survivors of HL (n = 1, 187; median age, 31. 2 years) completed a questionnaire evaluating vigorous-intensity exercise behavior. CV events were collected in follow-up questionnaires and graded according to Common Terminology Criteria for Adverse Events (version 4. 03). The primary end point was incidence of any major (grade 3 to 5) CV event. Poisson regression analyses were used to estimate the association between exercise exposure (metabolic equivalent [MET] hours/week -1 ) and risk of major CV events after adjustment for clinica covariates and cancer treatment.

Results: Median follow-up was 11. 9 years (range, 1. 7 to 14. 3 years). Cumulative incidence of any CV event was 12. 2% at 10 years for survivors reporting 0 MET hours/week -1 compared with 5. 2% for those reporting ≥ 9 MET hours/week -1 . In multivariable analyses, the incidence of any CV event decreased across increasing MET categories (P trend =. 002). Compared with survivors reporting 0 MET hours/week -1 , the adjusted rate ratio for any CV event was 0. 87 (95% CI, 0. 56 to 1. 34) for 3 to 6 MET hours/week -1 , 0. 45 (95% CI, 0. 26 to 0. 80) for 9 to 12 MET hours/week -1 , and 0. 47 (95% CI, 0. 23 to 0. 95) for 15 to 21 MET hours/week -1 . Adherence to national vigorous intensity exercise guidelines (ie, ≥ 9 MET hours/week -1 ) was associated with a 51% reduction in the risk of any CV event in comparison with not meeting the guidelines (P =. 002).

Conclusion: Vigorous exercise was associated with a lower risk of CV events in a dose-dependent manner ndependent of CV risk profile and treatment in survivors of HL.

Original languageEnglish (US)
Pages (from-to)3643-3650
Number of pages8
JournalJournal of Clinical Oncology
Volume32
Issue number32
DOIs
StatePublished - Nov 10 2014

Fingerprint

Metabolic Equivalent
Hodgkin Disease
Exercise
Neoplasms
Incidence
Guidelines
Risk Reduction Behavior
Terminology
Regression Analysis

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

Exercise and risk of major cardiovascular events in adult survivors of childhood Hodgkin lymphoma : A report from the childhood cancer survivor study. / Jones, Lee W.; Liu, Qi; Armstrong, Gregory; Ness, Kirsten K.; Yasui, Yutaka; Devine, Katie; Tonorezos, Emily; Soares-Miranda, Luisa; Sklar, Charles A.; Douglas, Pamela S.; Robison, Leslie L.; Oeffinger, Kevin C.

In: Journal of Clinical Oncology, Vol. 32, No. 32, 10.11.2014, p. 3643-3650.

Research output: Contribution to journalArticle

Jones, LW, Liu, Q, Armstrong, G, Ness, KK, Yasui, Y, Devine, K, Tonorezos, E, Soares-Miranda, L, Sklar, CA, Douglas, PS, Robison, LL & Oeffinger, KC 2014, 'Exercise and risk of major cardiovascular events in adult survivors of childhood Hodgkin lymphoma: A report from the childhood cancer survivor study', Journal of Clinical Oncology, vol. 32, no. 32, pp. 3643-3650. https://doi.org/10.1200/JCO.2014.56.7511
Jones, Lee W. ; Liu, Qi ; Armstrong, Gregory ; Ness, Kirsten K. ; Yasui, Yutaka ; Devine, Katie ; Tonorezos, Emily ; Soares-Miranda, Luisa ; Sklar, Charles A. ; Douglas, Pamela S. ; Robison, Leslie L. ; Oeffinger, Kevin C. / Exercise and risk of major cardiovascular events in adult survivors of childhood Hodgkin lymphoma : A report from the childhood cancer survivor study. In: Journal of Clinical Oncology. 2014 ; Vol. 32, No. 32. pp. 3643-3650.
@article{288d450ef7f8410789400163b2567de8,
title = "Exercise and risk of major cardiovascular events in adult survivors of childhood Hodgkin lymphoma: A report from the childhood cancer survivor study",
abstract = "Purpose: Survivors of Hodgkin lymphoma (HL) are at increased risk of treatment-related cardiovascular (CV) events; whether exercise modifies this risk is unknown. Methods: Survivors of HL (n = 1, 187; median age, 31. 2 years) completed a questionnaire evaluating vigorous-intensity exercise behavior. CV events were collected in follow-up questionnaires and graded according to Common Terminology Criteria for Adverse Events (version 4. 03). The primary end point was incidence of any major (grade 3 to 5) CV event. Poisson regression analyses were used to estimate the association between exercise exposure (metabolic equivalent [MET] hours/week -1 ) and risk of major CV events after adjustment for clinica covariates and cancer treatment. Results: Median follow-up was 11. 9 years (range, 1. 7 to 14. 3 years). Cumulative incidence of any CV event was 12. 2{\%} at 10 years for survivors reporting 0 MET hours/week -1 compared with 5. 2{\%} for those reporting ≥ 9 MET hours/week -1 . In multivariable analyses, the incidence of any CV event decreased across increasing MET categories (P trend =. 002). Compared with survivors reporting 0 MET hours/week -1 , the adjusted rate ratio for any CV event was 0. 87 (95{\%} CI, 0. 56 to 1. 34) for 3 to 6 MET hours/week -1 , 0. 45 (95{\%} CI, 0. 26 to 0. 80) for 9 to 12 MET hours/week -1 , and 0. 47 (95{\%} CI, 0. 23 to 0. 95) for 15 to 21 MET hours/week -1 . Adherence to national vigorous intensity exercise guidelines (ie, ≥ 9 MET hours/week -1 ) was associated with a 51{\%} reduction in the risk of any CV event in comparison with not meeting the guidelines (P =. 002). Conclusion: Vigorous exercise was associated with a lower risk of CV events in a dose-dependent manner ndependent of CV risk profile and treatment in survivors of HL.",
author = "Jones, {Lee W.} and Qi Liu and Gregory Armstrong and Ness, {Kirsten K.} and Yutaka Yasui and Katie Devine and Emily Tonorezos and Luisa Soares-Miranda and Sklar, {Charles A.} and Douglas, {Pamela S.} and Robison, {Leslie L.} and Oeffinger, {Kevin C.}",
year = "2014",
month = "11",
day = "10",
doi = "10.1200/JCO.2014.56.7511",
language = "English (US)",
volume = "32",
pages = "3643--3650",
journal = "Journal of Clinical Oncology",
issn = "0732-183X",
publisher = "American Society of Clinical Oncology",
number = "32",

}

TY - JOUR

T1 - Exercise and risk of major cardiovascular events in adult survivors of childhood Hodgkin lymphoma

T2 - A report from the childhood cancer survivor study

AU - Jones, Lee W.

AU - Liu, Qi

AU - Armstrong, Gregory

AU - Ness, Kirsten K.

AU - Yasui, Yutaka

AU - Devine, Katie

AU - Tonorezos, Emily

AU - Soares-Miranda, Luisa

AU - Sklar, Charles A.

AU - Douglas, Pamela S.

AU - Robison, Leslie L.

AU - Oeffinger, Kevin C.

PY - 2014/11/10

Y1 - 2014/11/10

N2 - Purpose: Survivors of Hodgkin lymphoma (HL) are at increased risk of treatment-related cardiovascular (CV) events; whether exercise modifies this risk is unknown. Methods: Survivors of HL (n = 1, 187; median age, 31. 2 years) completed a questionnaire evaluating vigorous-intensity exercise behavior. CV events were collected in follow-up questionnaires and graded according to Common Terminology Criteria for Adverse Events (version 4. 03). The primary end point was incidence of any major (grade 3 to 5) CV event. Poisson regression analyses were used to estimate the association between exercise exposure (metabolic equivalent [MET] hours/week -1 ) and risk of major CV events after adjustment for clinica covariates and cancer treatment. Results: Median follow-up was 11. 9 years (range, 1. 7 to 14. 3 years). Cumulative incidence of any CV event was 12. 2% at 10 years for survivors reporting 0 MET hours/week -1 compared with 5. 2% for those reporting ≥ 9 MET hours/week -1 . In multivariable analyses, the incidence of any CV event decreased across increasing MET categories (P trend =. 002). Compared with survivors reporting 0 MET hours/week -1 , the adjusted rate ratio for any CV event was 0. 87 (95% CI, 0. 56 to 1. 34) for 3 to 6 MET hours/week -1 , 0. 45 (95% CI, 0. 26 to 0. 80) for 9 to 12 MET hours/week -1 , and 0. 47 (95% CI, 0. 23 to 0. 95) for 15 to 21 MET hours/week -1 . Adherence to national vigorous intensity exercise guidelines (ie, ≥ 9 MET hours/week -1 ) was associated with a 51% reduction in the risk of any CV event in comparison with not meeting the guidelines (P =. 002). Conclusion: Vigorous exercise was associated with a lower risk of CV events in a dose-dependent manner ndependent of CV risk profile and treatment in survivors of HL.

AB - Purpose: Survivors of Hodgkin lymphoma (HL) are at increased risk of treatment-related cardiovascular (CV) events; whether exercise modifies this risk is unknown. Methods: Survivors of HL (n = 1, 187; median age, 31. 2 years) completed a questionnaire evaluating vigorous-intensity exercise behavior. CV events were collected in follow-up questionnaires and graded according to Common Terminology Criteria for Adverse Events (version 4. 03). The primary end point was incidence of any major (grade 3 to 5) CV event. Poisson regression analyses were used to estimate the association between exercise exposure (metabolic equivalent [MET] hours/week -1 ) and risk of major CV events after adjustment for clinica covariates and cancer treatment. Results: Median follow-up was 11. 9 years (range, 1. 7 to 14. 3 years). Cumulative incidence of any CV event was 12. 2% at 10 years for survivors reporting 0 MET hours/week -1 compared with 5. 2% for those reporting ≥ 9 MET hours/week -1 . In multivariable analyses, the incidence of any CV event decreased across increasing MET categories (P trend =. 002). Compared with survivors reporting 0 MET hours/week -1 , the adjusted rate ratio for any CV event was 0. 87 (95% CI, 0. 56 to 1. 34) for 3 to 6 MET hours/week -1 , 0. 45 (95% CI, 0. 26 to 0. 80) for 9 to 12 MET hours/week -1 , and 0. 47 (95% CI, 0. 23 to 0. 95) for 15 to 21 MET hours/week -1 . Adherence to national vigorous intensity exercise guidelines (ie, ≥ 9 MET hours/week -1 ) was associated with a 51% reduction in the risk of any CV event in comparison with not meeting the guidelines (P =. 002). Conclusion: Vigorous exercise was associated with a lower risk of CV events in a dose-dependent manner ndependent of CV risk profile and treatment in survivors of HL.

UR - http://www.scopus.com/inward/record.url?scp=84911932838&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84911932838&partnerID=8YFLogxK

U2 - 10.1200/JCO.2014.56.7511

DO - 10.1200/JCO.2014.56.7511

M3 - Article

VL - 32

SP - 3643

EP - 3650

JO - Journal of Clinical Oncology

JF - Journal of Clinical Oncology

SN - 0732-183X

IS - 32

ER -