American College of Cardiology
American College of Cardiology
Perspective from Ana Barac, MD, PhD, FACC
March 10, 2018
2 min read
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Congestive HF risk elevated in patients with breast cancer, lymphoma

Perspective from Ana Barac, MD, PhD, FACC
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Carolyn M. Larsen

ORLANDO, Fla. — Patients with breast cancer or lymphoma have a threefold elevated risk for congestive HF compared with adults without a history of cancer, according to new data presented at the American College of Cardiology Scientific Session.

Carolyn M. Larsen, MD, assistant professor of medicine at Mayo Clinic in Scottsdale, Arizona, and colleagues conducted a retrospective study of participants from the Rochester Epidemiology Project, matching 900 patients with breast cancer or lymphoma with 1,500 controls with no cancer history and followed them for new-onset congestive HF from 1985 to 2010 (median, 8.5 years).

“There was a gap in the existing knowledge of the long-term cardiovascular risk associated with anthracycline-based chemotherapy, which many patients with breast cancer and lymphoma receive,” Larsen told Cardiology Today. “This is a clinically important area because understanding the magnitude and duration of cardiovascular risk that breast cancer and lymphoma patients and survivors face is an essential step in developing guidelines for long-term clinical follow-up and surveillance imaging in this group of patients.”

Compared with those without a history of cancer, patients with breast cancer or lymphoma had elevated risk for new-onset congestive HF (HR = 3.65; 95% CI, 2.55-5.24). The curves began to separate at 1 year and were still separate at 20 years, Larsen and colleagues found.

Patients with breast cancer or lymphoma have a threefold elevated risk for congestive HF compared with adults without a history of cancer
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After adjustment for CAD, hypertension, hyperlipidemia, obesity, sex and radiation therapy, the researchers identified the following as independent risk factors for congestive HF in patients with breast cancer or lymphoma:

  • cumulative doxorubicin dose of at least 300 mg/m2 (HR = 2.34; 95% CI, 1.34-4.07);
  • age at diagnosis (HR for age 80 years vs. 60-69 years = 3.06; 95% CI, 1.23-7.31); and
  • diabetes (HR = 2.39; 95% CI, 1.24-4.59).

“While only a minority of breast cancer and lymphoma patients and survivors develop heart failure, our study demonstrates that 20 years after cancer diagnosis, they remain at increased risk of heart failure,” Larsen said in an interview. “Clinically, this is important to understand because it highlights the importance of ongoing surveillance such as assessing for signs and symptoms of heart failure at clinical follow-up visits in cancer patients and survivors.”

The findings on doxorubicin dose and diabetes are “important as it may help clinicians identify which cancer patients are at highest risk of heart failure and may benefit from closer follow-up,” she said.

Although the study did not answer the question of what doctors can do to mitigate the risk for congestive HF in patients with cancer, “we believe it is important that doctors screen for and help their patients in modifying coexisting cardiovascular risk factors including diabetes, hypertension, obesity, smoking and sedentary lifestyle to reduce their lifetime risk of cardiovascular disease, including heart failure,” Larsen said. “Cancer treatment can be lifesaving and we do not want to discourage treatment. We do want to make sure we are helping cancer patients and survivors care for their hearts during and after cancer therapy.” – by Erik Swain

Reference:

Larsen CM, et al. Abstract 1105-066. Presented at: American College of Cardiology Scientific Session; March 10-12, 2018; Orlando, Fla.

Disclosure: Larsen reports no relevant financial disclosures.