Exercise and risk of major cardiovascular events in adult survivors of childhood Hodgkin lymphoma: A report from the childhood cancer survivor study

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.