Incidence and Time on Onset of Cardiovascular Risk Factors and Cardiovascular Disease in Adult Survivors of Adolescent and Young Adult Cancer and Association with Exercise

摘要 许多癌症幸存者在治疗后有心血管并发症的风险。这些并发症会 包括心血管危险因素（CVRF），如糖尿病、高血压、血脂异常和肥胖， 心血管疾病（CVD），如心力衰竭、瓣膜性心脏病、缺血性心脏病/心肌梗死 梗塞和中风。那些被诊断为15至20岁的人被认为是青少年和年轻人 成年幸存者（AYA），经常接受心脏毒性治疗，这可能会增加其CVRF风险 和CVD。然而，很少有研究集中在了解CVRF和心血管疾病的发病率在这一人群。一个 需要了解该人群中CVRF和CVD的发病率和至发作时间， 监测和健康促进干预。健康促进干预措施，如运动，可以保护 对抗CVRF和CVD的发展，因为运动已被证明可以减轻CVRF和CVD， 其他人口。然而，对CVRF，CVD和运动之间关系的理解尚不清楚， 这个人口。利用儿童癌症幸存者研究（CCSS）的数据，我们将评估 以及CVRF和CVD发作的时间以及CVRF，CVD和运动之间的关系， 在15到20岁的年龄组中被诊断出患有癌症。我们将确定干预措施，如运动， 这一人群的需求以及接受心脏毒性治疗的人群的需求是否增加。指导 根据癌症幸存者研究框架，该研究将针对15-20岁的以下具体目标 AYA癌症幸存者：1）比较以下幸存者之间CVRF的发生率和发作时间： 暴露于和未暴露于心脏毒性治疗以及根据心脏毒性癌症治疗的类型 （化疗、放疗或化疗+放疗），2）比较CVD的发病率和发病时间 暴露和未暴露于心脏毒性治疗的幸存者之间的差异， 接受心脏毒性癌症治疗，以及3）检查自我报告运动之间的纵向关联 （每周代谢当量任务）和三个时间点存活者中CVRF和CVD的发生率 (1999，2007年和2014年）。随附的职业发展计划将提供以下方面的培训： 和经验，B）运动在减轻CVRF和CVD中的作用， 癌症幸存者，和c）纵向和次级数据分析方法。共同实现职业发展 和研究计划将支持发展一个独立的护士科学家在癌症生存， 心脏毒性和运动。该提案将产生与心血管相关的重要知识 通过对接受心脏毒性治疗的风险分层，为癌症幸存者提供并发症。此外，本发明还 这项研究将增加对运动对CVRF和CVD影响的理解， 未来研究的基础，重点是开发和测试干预措施，以减轻CVRF和CVD， 年龄在15到20岁之间的癌症幸存者。

ABSTRACT Many cancer survivors are at risk for cardiovascular complications after treatment. These complications can include cardiovascular risk factors (CVRF) such as diabetes, hypertension, dyslipidemia, and obesity and cardiovascular disease (CVD) such as heart failure, valvular heart disease, ischemic heart disease/myocardial infarction, and stroke. Those diagnosed between 15 and 20 years old are considered adolescent and young adult survivors (AYA) and frequently treated with cardiotoxic treatments which may increase their risk for CVRF and CVD. Yet little research has focused on understanding CVRF and CVD incidence in this population. An understanding of the incidence and time to onset of CVRF and CVD in this population is needed to inform surveillance and health promotion interventions. Health promotion interventions, such as exercise, may protect against the development of CVRF and CVD, because exercise has been shown to mitigate CVRF and CVD in other populations. Yet an understanding of the relationships between CVRF, CVD and exercise is unclear among this population. Utilizing data from the Childhood Cancer Survivor Study (CCSS), we will assess the incidence and time to onset of CVRF and CVD as well as relationships between CVRF, CVD and exercise for those diagnosed with cancer in the 15-to-20-year-old age group. We will identify if interventions, such as exercise, are needed for this population and if the need is increased for those who receive cardiotoxic treatments. Guided by the Cancer Survivor Research Framework, the study will address the following specific aims in 15-20 year old AYA cancer survivors: 1) Compare the incidence and time to onset of CVRF between survivors who were exposed and not exposed to cardiotoxic treatment and according to the type of cardiotoxic cancer treatments (chemotherapy, radiation, or chemo + radiation) received, 2) Compare the incidence and time to onset of CVD between survivors who were exposed and not exposed to cardiotoxic treatments and according to the type of cardiotoxic cancer treatments received, and 3) Examine longitudinal associations between self-report exercise (weekly metabolic equivalence tasks) and the incidence of CVRF and CVD in survivors across three time points (1999, 2007, and 2014). The accompanying career development plan will provide training in a) the unique needs and experiences of adult survivors of AYA cancers, b) the role exercise plays in mitigating CVRF and CVD for cancer survivors, and c) longitudinal and secondary data analyses methods. Together, the career development and research plan will support the development of an independent nurse scientist in cancer survivorship, cardiotoxicity, and exercise. This proposal will generate important knowledge related to cardiovascular complications for cancer survivors by creating risk stratification for receipt of cardiotoxic treatments. Additionally, this research will increase understanding of the effects that exercise has on CVRF and CVD, laying the foundation for future research focused on developing and testing interventions to mitigate CVRF and CVD among cancer survivors diagnosed between 15-and-20-years of age.