Patients With Heart Failure Have an Increased Risk of Incident Cancer

Abstract

Objective To evaluate the risk of cancer in patients with heart failure (HF) compared to community controls and its impact on outcome. Background HF is associated with excess morbidity and mortality. Non-cardiac causes of adverse outcomes in HF are increasingly recognized but not fully characterized. Methods In a case-control study, we compared history of cancer among community subjects newly diagnosed with HF from 1979–2002 to age-, sex-, and date-matched community controls without HF (961 pairs). Individuals without cancer at index (596 pairs) were followed for cancer in a cohort design, and the survival of HF patients who developed cancer was assessed. Results Before index, 22% of HF cases and 23% of controls had a history of cancer (odds ratio 0.94; 95% CI 0.75–1.17). During 9,203 person-years of follow-up [mean (SD), 7.7 (6.4) years], 244 new cancer cases were identified; HF patients had a 68% higher risk of developing cancer [hazard ratio (HR) 1.68; 95% CI 1.13–2.50] adjusted for body mass index, smoking and comorbidities. The HRs were similar for men and women with a trend toward a stronger association among subjects ≤75 years (P=0.22) and during the most recent time period (P=0.075). Among HF cases, incident cancer increased the risk of death (HR 1.56; 95% CI 1.22–1.99) adjusted for age, sex, year and comorbidities. Conclusions HF patients are at increased risk of cancer, which appears to have increased over time. Cancer increases mortality in HF underscoring the importance of non-cardiac morbidity and of cancer surveillance in the management of HF patients.

Incidence of cancer in patients with chronic heart failure: a long‐term follow‐up study

“…The increased incidence of cancer observed in the present study is in agreement with a recent study of 596 American HF patients, which reported a 60% increased risk of cancer. The risk remained increased after adjustment for shared risk factors such as smoking and body mass index . Even though our cohort was ∼5 years younger, with an average age of 67.8 years compared with the American cohort, the two cohorts were comparable with regard to co‐morbidities such as diabetes and prior myocardial infarction.…”

“…With cancer being a major source of morbidity and mortality and a recent study suggesting an increased risk of cancer among American chronic HF patients, the aim of the present study was to assess the incidence and risk of major types of cancer in a large Danish cohort with HF compared with the general population by using nationwide Danish administrative registries with complete follow‐up. In addition, this study reviewed the prognosis after a diagnosis of cancer in patients with HF compared with the background population.…”

Heart Failure After Myocardial Infarction Is Associated With Increased Risk of Cancer

“…Although usually considered a separate cause of morbidity, it may be that an association exists between heart disease and an increased risk of cancer. Our group has indeed shown a 70% increased risk of cancer among HF patients in Olmsted County, Minnesota compared with community controls (3). In that study, controls were matched to HF patients by age and sex, and efforts were made to comprehensively adjust for other recognized factors.…”

“…We previously reported an increased risk of cancer among HF patients as compared with community controls (3). In the present, study, the HF and non-HF patients shared many of the risk factors, diagnostic procedures, and medications because all patients were survivors of MI.…”

Prediction by Low Plasma HbA1c of Mortality, Cardiac and Noncardiac Disease Risk: Modulation by Diabetic Status and Sex

“…20 In line with this current significant independent inverse association of HbA 1c with LVEF among diabetic patients and an insignificant trend to positive association in nondiabetic subjects, prediction herein of a composite endpoint comprising both HF and malignancy further supports the report that patients with HF have an increased risk of incident cancer. 21 …”