Heart failure tied to increased cancer risk

Patients with heart failure (HF) may have an elevated risk of being diagnosed with cancer, according to a retrospective study from Germany presented at the Heart Failure 2021 congress.

Using the Disease Analyser database, the researchers identified 100,124 adults with an initial diagnosis of HF and matched them with 100,124 non-HF controls from 1,274 general practices in Germany between 2000 and 2018 (mean age 72.6 years, 54 percent female). Participants were matched according to age, sex, diabetes, obesity, and annual frequency of consultations. About 37 percent of participants had diabetes and 15.9 percent were obese.

Incidence of new cancer diagnosis over the 10-year observation period was significantly higher among patients with vs without HF (25.7 percent vs 16.2 percent; p<0.001), with the incidence elevated regardless of sex (female: 28.6 percent vs 18.8 percent; male: 23.2 percent vs 13.8 percent; p<0.001 for both). [ESC Heart Fail 2021;doi:10.1002/ehf2.13421]

Regression analysis showed an increased risk of cancer among patients with HF (hazard ratio [HR], 1.76, 95 percent confidence interval [CI], 1.71–1.81; p<0.001), in both women (HR, 1.85, 95 percent CI, 1.77–1.92) and men (HR, 1.69, 95 percent CI, 1.63–1.76; p<0.001 for both).

The strongest association between HF and cancer was noted for lip, oral cavity, and pharyngeal cancer (HR, 2.10, 95 percent CI, 1.66–2.17), followed by respiratory cancer (HR, 1.91, 95 percent CI, 1.74–2.10) and female genital cancers (HR, 1.86, 95 percent CI, 1.56–2.17; p<0.001 for all).

The risk was also elevated for all other cancers assessed, including skin tumours (HR, 1.83, 95 percent CI, 1.72–1.94), lymphoid and haematopoietic cancers (HR, 1.77, 95 percent CI, 1.63–1.91), gastrointestinal tract cancers (HR, 1.75, 95 percent CI, 1.64–1.87), breast cancer (HR, 1.67, 95 percent CI, 1.52–1.84), genitourinary tract cancer (HR, 1.64, 95 percent CI, 1.48–1.81), and male genital cancers (HR, 1.52, 95 percent CI, 1.40–1.66; p<0.001 for all).

“Our study demonstrates that HF patients have a significantly increased incidence of cancer in general and of each individual cancer type studied,” said the authors.

“This was an observational study and the results do not prove that HF causes cancer,” pointed out study author Dr Mark Luedde from the Christian-Albrechts-University, Kiel, and Cardiology Joint Practice Bremerhaven, Germany.

“[However,] our results allow us to speculate that there may be a causal relationship between HF 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,” he continued.

“[T]he occurrence of certain pathomechanisms such as chronic inflammation or increased free radical formation … may interact with a certain genetic background to connect both HF and cancer,” he suggested. “Another interesting hypothesis suggests that HF is an oncogenic condition.”

The analysis was adjusted for risk factors such as diabetes and obesity, suggesting that the outcomes could not be explained by these factors that are common to both cardiovascular disease and cancer.

He highlighted that the database did not provide information on certain lifestyle factors such as alcohol consumption, physical activity, and smoking, the latter of which could have played a crucial role in the high risk of oropharyngeal cancer seen in this study.

“It is common practice for cancer patients who have received heart-damaging drugs to be monitored for HF. Conversely, evidence is accumulating to indicate that HF patients could benefit from intensive monitoring for cancer development – for example through screening. Considering the high incidence of both diseases and their impact on the lives of those affected, these patients deserve the maximum joint efforts of cardiologists and oncologists,” concluded Luedde.