{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T19:39:13Z","timestamp":1781206753865,"version":"3.54.1"},"reference-count":48,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2021,5,2]],"date-time":"2021-05-02T00:00:00Z","timestamp":1619913600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Hallym University Research Fund","award":["HRF 202005-008"],"award-info":[{"award-number":["HRF 202005-008"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>We aimed to assess which lifestyle risk behaviors have the greatest influence on the risk of cardiovascular disease in cancer survivors and which of these behaviors are most prominently clustered in cancer survivors, using logistic regression and association rule mining (ARM). We analyzed a consecutive series of 897 cancer survivors from the Korean National Health and Nutritional Exam Survey (2012\u20132016). Cardiovascular disease risks were assessed using the atherosclerotic cardiovascular disease score (ASCVDs). We classified participants as being in a low-risk group if their calculated ASCVDs was less than 10% and as being in a high-risk group if their score was 10% or higher. We used association rule mining to analyze patterns of lifestyle risk behaviors by ASCVDs risk group, based upon public health recommendations described in the Alameda 7 health behaviors (current smoking, heavy drinking, physical inactivity, obesity, breakfast skipping, frequent snacking, and suboptimal sleep duration). Forty-two percent of cancer survivors had a high ASCVD. Current smoking (common odds ratio, 11.19; 95% confidence interval, 3.66\u201334.20, p &lt; 0.001) and obesity (common odds ratio, 2.67; 95% confidence interval, 1.40\u20135.08, p &lt; 0.001) were significant predictors of high ASCVD in cancer survivors within a multivariate model. In ARM analysis, current smoking and obesity were identified as important lifestyle risk behaviors in cancer survivors. In addition, various lifestyle risk behaviors co-occurred with smoking in male cancer survivors.<\/jats:p>","DOI":"10.3390\/jpm11050366","type":"journal-article","created":{"date-parts":[[2021,5,2]],"date-time":"2021-05-02T08:05:21Z","timestamp":1619942721000},"page":"366","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["An Association Rule Mining Analysis of Lifestyle Behavioral Risk Factors in Cancer Survivors with High Cardiovascular Disease Risk"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9495-8014","authenticated-orcid":false,"given":"Su Jung","family":"Lee","sequence":"first","affiliation":[{"name":"Research Institute on Nursing Science, School of Nursing, Hallym University, 1 Hallymdaehak-gil, Chuncheon-si 24252, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen B.","family":"Cartmell","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences, Clemson University, 519 Edwards Hall, Alpha Epsilon Drive, Clemson, SC 29634, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,5,2]]},"reference":[{"key":"ref_1","unstructured":"National Cancer Information Center (2019, December 30). Five Year Relative Survival Rate of Patients with Cancer in Korea 2017, Available online: https:\/\/www.cancer.go.kr."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Ning, Y., Shen, Q., Herrick, K., Mikkelsen, R., Anscher, M., Houlihan, R., and Lapane, K. (April, January 31). Abstract LB-339: Cause of Death in Cancer Survivors. Proceedings of the AACR 103rd Annual Meeting 2012, Chicago, IL, USA. Abstract nr LB-339.","DOI":"10.1158\/1538-7445.AM2012-LB-339"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1368","DOI":"10.1093\/jnci\/djn310","article-title":"Cause-specific late mortality among 5-year survivors of childhood cancer: The Childhood Cancer Survivor Study","volume":"100","author":"Mertens","year":"2008","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1626","DOI":"10.1200\/JCO.2015.65.5845","article-title":"Cardiovascular disease risk profiles in survivors of adolescent and young adult (AYA) cancer: The Kaiser Permanente AYA Cancer Survivors Study","volume":"34","author":"Chao","year":"2016","journal-title":"J. Clin. Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1097\/EDE.0000000000000394","article-title":"Cardiovascular disease mortality among breast cancer survivors","volume":"27","author":"Bradshaw","year":"2016","journal-title":"Epidemiol. (Camb. Mass.)"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1122","DOI":"10.1200\/JCO.2015.64.0409","article-title":"Cardiovascular disease among survivors of adult-onset cancer: A community-based retrospective cohort study","volume":"34","author":"Armenian","year":"2016","journal-title":"J. Clin. Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1161\/CIRCULATIONAHA.116.024811","article-title":"Population-based long-term cardiac-specific mortality among 34 489 five-year survivors of childhood cancer in Great Britain","volume":"135","author":"Fidler","year":"2017","journal-title":"Circulation"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1016\/j.ejca.2018.12.021","article-title":"Late mortality and causes of death among 5-year survivors of childhood cancer diagnosed in the period 1960\u20131999 and registered in the Italian Off-Therapy Registry","volume":"110","author":"Bagnasco","year":"2019","journal-title":"Eur. J. Cancer"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"214","DOI":"10.2174\/157340311799960645","article-title":"Anthracycline cardiotoxicity: Prevalence, pathogenesis and treatment","volume":"7","author":"Volkova","year":"2011","journal-title":"Curr. Cardiol. Rev."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1007\/s10549-008-0260-6","article-title":"Trastuzumab mediated cardiotoxicity in the setting of adjuvant chemotherapy for breast cancer: A retrospective study","volume":"117","author":"Wadhwa","year":"2009","journal-title":"Breast Cancer Res. Treat."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1116","DOI":"10.1016\/j.ijrobp.2017.03.026","article-title":"Late cardiac toxicity after mediastinal radiation therapy for Hodgkin lymphoma: Contributions of coronary artery and whole heart dose-volume variables to risk prediction","volume":"98","author":"Hahn","year":"2017","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1007\/s11912-017-0601-x","article-title":"Cancer as a risk factor for cardiovascular disease","volume":"19","author":"Giza","year":"2017","journal-title":"Curr. Oncol. Rep."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1359","DOI":"10.1200\/JCO.2003.06.131","article-title":"Obesity in adult survivors of childhood acute lymphoblastic leukemia: A report from the Childhood Cancer Survivor Study","volume":"21","author":"Oeffinger","year":"2003","journal-title":"J. Clin. Oncol."},{"key":"ref_14","unstructured":"Lalonde, M.A. (1974). A New Perspective on the Health of Canadians: A Working Document."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Krokstad, S., Ding, D., Grunseit, A.C., Sund, E.R., Holmen, T.L., Rangul, V., and Bauman, A. (2017). Multiple lifestyle behaviours and mortality, findings from a large population-based Norwegian cohort study-The HUNT Study. BMC Public Health, 17.","DOI":"10.1186\/s12889-016-3993-x"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1016\/S0140-6736(03)13968-2","article-title":"Estimates of global and regional potential health gains from reducing muliple major risk factors","volume":"362","author":"Ezzati","year":"2003","journal-title":"Lancet"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1007\/s11764-013-0295-5","article-title":"Trends in modifiable lifestyle-related risk factors following diagnosis in breast cancer survivors","volume":"7","author":"Zhao","year":"2013","journal-title":"J. Cancer Surviv."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e546","DOI":"10.3747\/co.23.3166","article-title":"Socioeconomic status and lifestyle behaviours in cancer survivors: Smoking and physical activity","volume":"23","author":"Naik","year":"2016","journal-title":"Curr. Oncol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/0091-7435(73)90009-1","article-title":"Relationship of health practices and mortality","volume":"2","author":"Belloc","year":"1973","journal-title":"Prev. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"73","DOI":"10.3961\/jpmph.2010.43.1.73","article-title":"High risk groups in health behavior defined by clustering of smoking, alcohol, and exercise habits: National Heath and Nutrition Examination Survey","volume":"43","author":"Kang","year":"2010","journal-title":"J. Prev. Med. Public Health"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"183","DOI":"10.3961\/jpmph.2013.46.4.183","article-title":"Drinking patterns among Korean adults: Results of the 2009 Korean community health survey","volume":"46","author":"Ryu","year":"2013","journal-title":"J. Prev. Med. Public Health"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1081","DOI":"10.1161\/CIRCULATIONAHA.107.185649","article-title":"Physical activity and public health: Updated recommendation for adults from the American College of Sports Medicine and the American Heart Association","volume":"116","author":"Haskell","year":"2007","journal-title":"Circulation"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Park, S.H., Jang, S.Y., Kim, H., and Lee, S.W. (2014). An association rule mining-based framework for understanding lifestyle risk behaviors. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0088859"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1027","DOI":"10.1016\/j.socscimed.2010.05.041","article-title":"Short and long sleep are positively associated with obesity, diabetes, hypertension, and cardiovascular disease among adults in the United States","volume":"71","author":"Buxton","year":"2010","journal-title":"Soc. Sci. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2935","DOI":"10.1016\/j.jacc.2013.11.005","article-title":"2013 ACC\/AHA guideline on the assessment of cardiovascular risk: A report of the American College of Cardiology\/American Heart Association Task Force on Practice Guidelines","volume":"63","author":"Goff","year":"2014","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1145\/170036.170072","article-title":"Mining association rules between sets of items in large databases","volume":"Volume 22","author":"Agrawal","year":"1993","journal-title":"Proceedings of the 1993 ACM SIGMOD, International Conference on Management of Data"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1007\/s10462-016-9483-9","article-title":"Applications of association rule mining in health informatics: A survey","volume":"47","author":"Altaf","year":"2017","journal-title":"Artif. Intell. Rev."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"012017","DOI":"10.1088\/1742-6596\/1007\/1\/012017","article-title":"Mining association rule based on the diseases population for recommendation of medicine need","volume":"1007","author":"Harahap","year":"2018","journal-title":"J. Phys. Conf. Ser."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"3244","DOI":"10.1161\/01.CIR.0000133321.00456.00","article-title":"Preventing cancer, cardiovascular disease, and diabetes: A common agenda for the American Cancer Society, the American Diabetes Association, and the American Heart Association","volume":"109","author":"Eyre","year":"2004","journal-title":"Circulation"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1188\/07.ONF.643-651","article-title":"Health behaviors in cancer survivors","volume":"34","author":"Mayer","year":"2007","journal-title":"Oncol. Nurs. Forum"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1007\/s11764-018-0728-2","article-title":"Smoking cessation attitudes and practices among cancer survivors-United States, 2015","volume":"13","author":"Gallaway","year":"2019","journal-title":"J. Cancer Surviv."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1007\/s11764-016-0581-0","article-title":"Do cancer survivors develop healthier lifestyle behaviors than the cancer-free population in the PLCO study?","volume":"11","author":"Hawkins","year":"2017","journal-title":"J. Cancer Surviv."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/j.annepidem.2014.11.008","article-title":"What proportion of cancer deaths in the contemporary United States is attributable to cigarette smoking?","volume":"25","author":"Jacobs","year":"2015","journal-title":"Ann. Epidemiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1158\/1055-9965.EPI-16-0748","article-title":"Tobacco use and cancer risk in the Agricultural Health Study","volume":"26","author":"Andreotti","year":"2017","journal-title":"Cancer Epidemiol. Biomark. Prev."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"885","DOI":"10.1200\/JCO.2014.58.3831","article-title":"Active smoking and mortality among colorectal cancer survivors: The Cancer Prevention Study II nutrition cohort","volume":"33","author":"Yang","year":"2015","journal-title":"J. Clin. Oncol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1161\/ATVBAHA.113.300156","article-title":"Smoking and cardiovascular disease: Mechanisms of endothelial dysfunction and early atherogenesis","volume":"34","author":"Messner","year":"2014","journal-title":"Arterioscler. Thromb. Vasc. Biol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1200\/JOP.0912001","article-title":"Smoking behaviors among cancer survivors: An observational clinical study","volume":"5","author":"Burke","year":"2009","journal-title":"J. Oncol. Pract."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.mito.2014.10.008","article-title":"Physical exercise prior and during treatment reduces sub-chronic doxorubicin-induced mitochondrial toxicity and oxidative stress","volume":"20","author":"Mariani","year":"2015","journal-title":"Mitochondrion"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"3643","DOI":"10.1200\/JCO.2014.56.7511","article-title":"Exercise and risk of major cardiovascular events in adult survivors of childhood hodgkin lymphoma: A report from the childhood cancer survivor study","volume":"32","author":"Jones","year":"2014","journal-title":"J. Clin. Oncol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"e17487","DOI":"10.2196\/17487","article-title":"Association rule mining and prognostic stratification of 2-year longevity in octogenarians undergoing endovascular therapy for lower extremity arterial disease: Observational cohort study","volume":"22","author":"Jhang","year":"2020","journal-title":"J. Med. Internet Res."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Sch\u00e4fer, I., Kaduszkiewicz, H., Wagner, H.O., Sch\u00f6n, G., Scherer, M., and van den Bussche, H. (2014). Reducing complexity: A visualisation of multimorbidity by combining disease clusters and triads. BMC Public Health, 14.","DOI":"10.1186\/1471-2458-14-1285"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"197","DOI":"10.3233\/THC-171322","article-title":"Mining association rules between stroke risk factors based on the apriori algorithm","volume":"25","author":"Li","year":"2017","journal-title":"Technol. Health Care"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/j.eswa.2017.01.001","article-title":"A new multiple seeds based genetic algorithm for discovering a set of interesting Boolean association rules","volume":"74","author":"Kabir","year":"2017","journal-title":"Expert Syst. Appl."},{"key":"ref_44","first-page":"1399","article-title":"Mining association rules from clinical databases: An intelligent diagnostic process in healthcare","volume":"84","author":"Stilou","year":"2001","journal-title":"Stud. Health Technol. Inform."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1016\/S0140-6736(02)09958-0","article-title":"The effect of diet on risk of cancer","volume":"360","author":"Key","year":"2002","journal-title":"Lancet"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.1093\/ije\/dyw319","article-title":"Fruit and vegetable intake and the risk of cardiovascular disease, total cancer and all-cause mortality-a systematic review and dose-response meta-analysis of prospective studies","volume":"46","author":"Aune","year":"2017","journal-title":"Int. J. Epdemiol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1016\/j.jacc.2017.05.047","article-title":"Healthful and Unhealthful Plant-Based Diets and the Risk of Coronary Heart Disease in U.S. Adults","volume":"70","author":"Satija","year":"2017","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Satija, A., Bhupathiraju, S.N., Rimm, E.B., Spiegelman, D., Chiuve, S.E., Borgi, L., Willett, W.C., Manson, J.E., Sun, Q., and Hu, F.B. (2016). Plant-Based Dietary Patterns and Incidence of Type 2 Diabetes in US Men and Women: Results from Three Prospective Cohort Studies. PLoS Med., 13.","DOI":"10.1371\/journal.pmed.1002039"}],"container-title":["Journal of Personalized Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4426\/11\/5\/366\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:56:42Z","timestamp":1760162202000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4426\/11\/5\/366"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,2]]},"references-count":48,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2021,5]]}},"alternative-id":["jpm11050366"],"URL":"https:\/\/doi.org\/10.3390\/jpm11050366","relation":{},"ISSN":["2075-4426"],"issn-type":[{"value":"2075-4426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5,2]]}}}