Exercise and risk of major cardiovascular events in adult survivors of childhood Hodgkin lymphoma: A report from the Childhood Cancer Survivor Study (CCSS).
Bibliographic record
Abstract
10023 Background: Adult survivors of childhood Hodgkin’s lymphoma are at elevated risk of treatment-related major cardiovascular (CV) events. We investigated whether exercise modified this association in HL survivors participating in the CCSS. Methods: HL survivors (n=1,187), median age 31.2 (range 18.0-48.9 years) and free of CV disease at baseline completed a questionnaire evaluating vigorous-intensity exercise behavior over the past week. Subsequent CV events were collected in follow-up questionnaires and graded according to the CTCAE (v. 4.03). The primary end point was incidence of any major (grade 3 to 5) CV event. Secondary end points were incidence of grade 3 to 5 CV events [coronary artery disease (CAD), heart failure, valve replacement, arrhythmia, and CV death]. Poisson regression analyses were used to estimate the association between exercise exposure [metabolic equivalent task-hrs.wk-1(MET)] and risk of major CV events after adjustment for important clinical covariates (age, smoking, education, CV risk factors, and baseline grade 3-4 health conditions) and cancer treatment (anthracycline exposure and chest radiation). Results: A total of 135 major CV events were reported after median follow-up of 11.9 (range 1.7 - 14.3) years. In multivariable-adjusted analyses, the incidence of any CV event declined across increasing MET categories (Ptrend=0.002). Compared with survivors reporting 0 METs, the adjusted RR for any CV event was 0.87 (95% CI, 0.56 to 1.34) for 3 to 6 METs, 0.45 (95% CI, 0.26 to 0.80) for 9 to 12 METs, and 0.47 (95% CI, 0.23 to 0.95) for 15 to 21 METs. A similar pattern was observed for the incidence of CAD (adjusted Ptrend=0.005). The cumulative incidence of any CV event was 12.2% at 10 years for survivors reporting 0 METs, compared to 5.2% for those reporting ≥9 METs. Adherence to national exercise guidelines (i.e., ≥9 METs) was associated with a 51% reduction in the risk of any CV event, in comparison with not meeting the guidelines (p=0.002). Conclusions: Vigorous exercise reduces the incidence of CV events in a dose-dependent mannerbeyond CV risk profile and treatment exposure in adult survivors of childhood HL.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".