Anthracycline treatment for cancer linked to increased risk of congestive heart failure

The use of anthracyclines in the treatment of cancer appears to carry a twofold risk of congestive heart failure (CHF), according to a study.

For the study, researchers used retrospective data from the Rochester Epidemiology Project, which involved residents of Olmsted County, Minnesota, US, diagnosed with breast cancer or lymphoma. These residents were matched with healthy controls according to age, sex, and comorbidities.

A total of 2,196 individuals (mean age 52.62 years, 78 percent women) were included, among whom 812 were diagnosed with cancer and 1,384 were healthy controls. The median follow-up was 8.6 years in the case group vs 12.5 years in the control group.

The primary endpoint of new-onset CHF occurred with significantly higher frequency in the case group than in the control cohort despite adjustments for potential confounding factors (hazard ratio [HR], 2.86, 95 percent confidence interval [CI], 1.90–4.32; p<0.001).

On further analysis, CHF risk was even higher among participants in the case group who received anthracycline (HR, 3.25, 95 percent CI, 2.11–5.00; p<0.001) but was attenuated among those who did not receive anthracyclines (HR, 1.78, 95 percent CI, 0.83–3.81; p=0.14).

The cumulative incidence of CHF among participants with cancer and who were given anthracyclines was higher than that among control participants at 1 year (1.81 percent vs 0.09 percent), 5 years (2.91 percent vs 0.79 percent), 10 years (5.36 percent vs 1.74 percent), 15 years (7.42 percent vs 3.18 percent), and 20 years (10.75 percent vs 4.98 percent; p<0.001).

CHF risk did not differ by anthracycline dose (<180 vs 180–250 mg/m²: HR, 0.54, 95 percent CI, 0.19–1.51; <180 vs >250 mg/m²: HR, 1.23, 95 percent CI, 0.52–2.91). Age at the time of cancer diagnosis was independently associated with CHF risk (HR per 10 years, 2.77, 95 percent CI, 1.99–3.86; p<0.001).