"This was an observational study and the results do not prove that heart failure causes cancer," said author Dr. Mark Luedde of the Christian-Albrechts-University of Kiel and Cardiology Joint Practice Bremerhaven, Germany. "However, the findings do suggest that heart failure patients may benefit from cancer prevention measures."
Heart failure affects around 65 million people worldwide.3 Some patients with cancer develop heart failure as a consequence of cancer treatment.4 More recently it has also emerged that heart failure patients may have an elevated incidence of cancer during the course of their heart disease, but most studies have been small.5-8
The current study investigated the association between heart failure and new cancer development in a large cohort. The study used information from the nationally representative Disease Analyser database, which covers 1,274 general practices in Germany.
A total of 100,124 patients with heart failure and 100,124 individuals without heart failure were included in the analysis. Heart failure patients and those without heart failure were individually matched by sex, age, obesity, diabetes, and consultation frequency. No participants had cancer at the start of the study. Statistical models were used to examine the association between heart failure and the incidence of cancer over 10 years.
The average age of the study population was 72.6 years and 54% were women. During the 10 year observation period, the incidence of cancer was significantly higher among heart failure patients (25.7%) compared to those without heart failure (16.2%). In women, the incidence of cancer was 28.6% in patients with heart failure and 18.8% in those without heart failure. In men the corresponding rates were 23.2% and 13.8%.
Heart failure was significantly associated with the incidence of cancer, with a hazard ratio of 1.76. The hazard ratios for women and men were 1.85 and 1.69, respectively.
Significant associations were found between heart failure and all cancer types assessed. The greatest increase in risk was observed for cancer of the lip, oral cavity, and pharynx, with a hazard ratio of 2.10, followed by respiratory organ cancer, with a hazard ratio of 1.91. The hazard ratios for other sites were 1.86 for female genital organ cancer, 1.83 for skin tumours, 1.77 for lymphoid and haematopoietic tissue cancer, 1.75 for digestive tract cancer, 1.67 for breast cancer, 1.64 for genitourinary tract cancer, and 1.52 for male genital organ cancer.
Dr. Luedde said: "Our results allow us to speculate that there may be a causal relationship between heart failure and an increased rate of cancer. This is biologically plausible, as there is experimental evidence that factors secreted by the failing heart may stimulate tumour growth."7
He continued: "While heart failure and cancer share common risk factors such as obesity and diabetes, these were accounted for in the analysis by matching. It should be noted that our database does not include information on smoking, alcohol consumption or physical activity, so we were unable to match for these in the analysis."
Dr. Luedde concluded: "It is common practice for cancer patients who have received heart-damaging drugs to be monitored for heart failure. Conversely, evidence is accumulating to indicate that heart failure patients could benefit from intensive monitoring for cancer development - for example through screening. Considering the high incidence of both
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Notes to editor
Funding: None.
Disclosures: None.
References and notes
1Abstract title: Heart failure and comorbidities.
2Roderburg C, Loosen SH, Jahn JK, et al. Heart failure is associated with an increased incidence of cancer diagnoses. ESC Heart Fail. 2021. doi:10.1002/ehf2.13421.
3Bragazzi NL, Zhong W, Shu J, et al. Burden of heart failure and underlying causes in 195 countries and territories from 1990 to 2017. Eur J Prev Cardiol. 2021. doi:10.1093/eurjpc/zwaa147.
4Zamorano JL, Lancellotti P, Muñoz DR, et al. 2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines. Eur Heart J. 2016;37:2768-2801.
5Banke A, Schou M, Videbaek L, et al. Incidence of cancer in patients with chronic heart failure: a long-term follow-up study. Eur J Heart Fail. 2016;18:260-266.
6Hasin T, Gerber Y, Weston SA, et al. Heart failure after myocardial infarction is associated with increased risk of cancer. J Am Coll Cardiol. 2016;68:265-271.
7Bertero E, Canepa M, Maack C, Ameri P. Linking heart failure to cancer: Background evidence and research perspectives. Circulation. 2018;138:735-742.
8Tini G, Bertero E, Signori A, et al. Cancer mortality in trials of heart failure with reduced ejection fraction: a systematic review and meta-analysis. J Am Heart Assoc. 2020;9:e016309.
About Heart Failure 2021 & World Congress on Acute Heart Failure
Heart Failure is the annual congress of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC).
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About the Heart Failure Association
The Heart Failure Association (HFA) is a branch of the European Society of Cardiology (ESC). Its aim is to improve quality of life and longevity, through better prevention, diagnosis and treatment of heart failure, including the establishment of networks for its management, education and research.
About the European Society of Cardiology
The European Society of Cardiology brings together health care professionals from more than 150 countries, working to advance cardiovascular medicine and help people lead longer, healthier lives.
About ESC Heart Failure
ESC Heart Failure is the open access journal of the Heart Failure Association (HFA) of the ESC.
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