Patients who develop HF after MI face an increased risk for cancer, according to study data published in the Journal of the American College of Cardiology.
Researchers analyzed data on 1,081 patients with MI in Olmstead County, Minnesota, from November 2002 to December 2010 (mean age, 64; 60% men) who participated in the Rochester Epidemiology Project. There were 5,327 person-years of follow-up (mean, 4.9 years).
“Our research suggests an association between [cancer and HF], and it’s possible that as we learn more about how this connection works, we can prevent deaths,” Veronique L. Roger, MD, director of the Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery at Mayo Clinic, said in a press release. “In the meantime, physicians should recognize this increased cancer risk for [patients with HF] and follow guideline-recommended surveillance and early detection practices.”
Veronique L. Roger
During the study period, 228 (21%) patients with MI progressed to HF and 98 developed cancer, excluding non-melanoma skin cancer. Median time to HF diagnosis was 3 days. The incidence density rates for a diagnosis of cancer were 33.7 per 1,000 patient-years for patients with HF and 15.6 per 1,000 patient-years for those without HF (P = .0002).
According to the researchers, those with HF had an elevated unadjusted risk for cancer (HR = 2.16, 95% CI, 1.39-3.35), which persisted after adjustment for age, sex and Charlson comorbidity index (HR = 1.71; 95% CI, 1.07-2.73).
HRs for mortality linked to cancer were 4.9 (95% CI, 3.1-7.74) for patients without HF and 3.91 (95% CI, 1.88-8.12) for those with HF (P for interaction = .76), the researchers found.
“The association between HF and cancer raises concerns regarding the effects of specific [CV] medications, including angiotensin receptor blockers, cardiac glycosides, diuretic agents, statins and prasugrel (Effient, Daiichi Sankyo/Eli Lilly),” Roger and colleagues wrote.
Age, sex and infarct size were among the factors contributing to HF onset, according to the researchers, who wrote, “Patients with subsequent HF were, on average, 10 years older, more likely to be women [and] with adverse risk factors and larger infarctions. They were also less likely to receive reperfusion/revascularization.”
In a related editorial, Jyoti Malhotra, MD, MPH, from Rutgers Cancer Institute of New Jersey, New Brunswick, and Paolo Boffetta, MD, MPH, from Icahn School of Medicine at Mount Sinai, wrote that “... it is unlikely that HF is playing a causative role in carcinogenesis because cancer has a latent period of at least a few years. ... However, a role in the late stages of the carcinogenic process ... cannot be excluded.”
Malhotra and Boffetta highlighted a potential limitation of the study regarding cancer diagnoses.
“Another factor to consider is that patients with MI who get HF may experience a more intense medical surveillance than other patients,” they wrote. “This could cause overdiagnosis and lead-time bias, with participants in the HF group getting diagnosed either with clinically irrelevant cancers or at an earlier stage of clinically relevant cancers.” – by James Clark
Disclosure: The researchers, Malhotra and Boffetta report no relevant financial disclosures.