Wogksch Matthew D, Ware Megan E, Onerup Aron, O'Neil Sean T, Nolan Vikki G, Smeltzer Matthew P, Mzayek Fawaz, Mulrooney Daniel A, Ehrhardt Matthew J, Dixon Stephanie B, Rhea Isaac B, Srivastava Deo Kumar, Armstrong Gregory T, Hudson Melissa M, Ness Kirsten K
Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN.
Department of Kinesiology Health Promotion & Recreation, University of North Texas, Denton, TX.
Med Sci Sports Exerc. 2025 Jul 1. doi: 10.1249/MSS.0000000000003802.
Childhood cancer survivors are at increased risk of premature cardiovascular events compared to peers. Increased cardiopulmonary fitness reduces the risk of cardiovascular morbidity/mortality within the general population but are poorly described in cancer survivors. We examined the associations between fitness and cardiovascular events in childhood cancer survivors.
Participants (n = 2,433) completed a baseline, cardiopulmonary exercise test (CPET) to assess peak maximal oxygen consumption (VO2peak). Metabolic equivalents (METs) were calculated by dividing VO2peak by 3.5 ml·kg1·min and peak METs achieved on CPET was used to document cardiopulmonary fitness. Additionally, we categorized participants (based on age- and sex-matched controls) as low (<50th percentile ofachieved METs) and normal ( ≥50th percentile). Subsequent cardiovascular disease was graded with the Common Terminology Criteria for Adverse Events v. 4.03. Associations between peak METs and subsequent cardiovascular disease in survivors were evaluated with multivariable Cox-proportional hazard regression, adjusted for cancer treatment, lifestyle, baseline cardiovascular disease, and cardiovascular risk factors. Additionally, a univariate analysis was conducted to examine the peak METs achieved on the CPET in survivors who died from a cardiovascular event and those who did not.
Each 1 MET increase on the survivor's CPET performance decreased the risk of incident cardiovascular disease (Hazard Ratio [HR] 0.80, 95% Confidence interval [CI] 0.72, 0.90). Among survivors with low baseline cardiopulmonary fitness, those who achieved 1 MET higher value on their CPET had lower risk of incident cardiovascular disease (HR:0.78, 95% CI 0.65, 0.96). The average peak METs achieved was lower (5.9 ± 2.17) among survivors who died from cardiovascular disease compared to those who did not (7.6 ± 2.5).
Higher cardiopulmonary fitness was associated with lower risk for incident cardiovascular disease. Early identification of survivors with low cardiopulmonary fitness provides opportunities for risk mitigation through promotion of regular physical activity.
与同龄人相比，儿童癌症幸存者发生心血管疾病过早事件的风险增加。心肺适能的提高可降低普通人群中心血管疾病发病/死亡的风险，但在癌症幸存者中这方面的描述较少。我们研究了儿童癌症幸存者的适能与心血管事件之间的关联。
参与者（n = 2433）完成了一项基线心肺运动试验（CPET），以评估最大摄氧量峰值（VO2peak）。代谢当量（METs）通过将VO2peak除以3.5 ml·kg-1·min来计算，CPET上达到的峰值METs用于记录心肺适能。此外，我们将参与者（基于年龄和性别匹配的对照组）分为低适能组（达到的METs低于第50百分位数）和正常适能组（≥第50百分位数）。随后根据不良事件通用术语标准第4.03版对心血管疾病进行分级。通过多变量Cox比例风险回归评估幸存者中峰值METs与随后心血管疾病之间的关联，并对癌症治疗、生活方式、基线心血管疾病和心血管危险因素进行了调整。此外，还进行了单变量分析，以检查死于心血管事件的幸存者和未死于心血管事件的幸存者在CPET上达到的峰值METs。
幸存者CPET表现每增加1 MET，发生心血管疾病的风险就会降低（风险比[HR] 0.80，95%置信区间[CI] 0.72，0.90）。在基线心肺适能较低的幸存者中，CPET上达到的值每高1 MET，发生心血管疾病的风险就越低（HR：0.78，95% CI 0.65，0.96）。与未死于心血管疾病的幸存者相比，死于心血管疾病的幸存者达到的平均峰值METs较低（5.9±2.17）（7.6±2.5）。
较高的心肺适能与较低的心血管疾病发病风险相关。早期识别心肺适能较低的幸存者为通过促进规律体育活动来降低风险提供了机会。
