Investigation Finds Statistical Relationship Between Heart Failure, Cancer Incidence

There is a 76% greater incidence of cancer development among patients with heart failure compared with individuals who do not have the chronic condition, and the incidence was higher among women compared with men, according to research that will be presented at Heart Failure 2021, this year’s online congress of the European Society of Cardiology.

The research is simultaneously being published in ESC Heart Failure.

The retrospective cohort study investigated the incidence of cancer overall overall and for specific types among 100,124 patients with heart failure and 100,124 persons without heart failure, matched for age, sex, diabetes status, obesity, and yearly consultation frequency. Diagnoses were made between January 2000 and December 2018 at 1000-plus general practices in Germany. The mean (SD) patient age in both groups was 72.6 (12.2) years, most were aged 71 to 80 years (34.9%, heart failure group; 35.2%, non–heart failure group), and diabetes was the most common comorbidity (37.4% in both groups). Data were provided by IQVIA’s Disease Analysis database.

"This was an observational study and the results do not prove that heart failure causes cancer," senior author Mark Luedde, PD Dr, MHBA, Christian-Albrecht University of Kiel and Cardiology Joint Practice Bremerhaven, Germany, said in a statement. "However, the findings do suggest that heart failure patients may benefit from cancer prevention measures."

Noting the significance of comorbidities often present in individuals with heart failure, the authors wrote that cancer has received increasing attention as of late, but that additional data are needed, “especially with regard to individual tumour types.”

In the 10-year follow-up period, the authors’ analysis found the following results when comparing incidences between the heart failure and non–heart failure groups (all P < .001), respectively:

• Overall incidence of cancer: 25.7% vs 16.2%
• Overall incidence among female patients: 28.6% vs 18.8%
• Overall incidence among male patients: 23.2% vs 13.8%

Statistically significant associations were seen as well for cancer incidence (all P < .001):

• The overall hazard ratio (HR) was 1.76 (95% CI, 1.71-1.81)
• Female patients with heart failure had an 85% increased cancer risk (HR, 1.85; 95% CI, 1.77-1.92)
• Male patients had a 69% increased cancer risk (HR, 1.69; 95% CI, 1.63-1.76)

Nine specific cancer types were also investigated, and the authors saw the following incidence rates among the patients with heart failure:

• 110% greater risk of cancer of lip, oral cavity, and pharynx (HR, 2.10; 95% CI, 1.66-2.17)
• 91% greater risk of respiratory organs cancer (HR, 1.91; 95% CI, 1.74-2.10)
• 86% greater risk of genital organ cancer among female patients (HR, 1.86; 95% CI, 1.56-2.17).
• 83% greater risk of skin tumors (HR, 1.83; 95% CI, 1.72-1.94)
• 77% greater risk of lymphoid and hematopoietic tissue cancer (HR, 1.77; 95% CI, 1.63-1.91)
• 75% greater risk of digestive tract cancer (HR, 1.75; 95% CI, 1.64-1. 87)
• 67% greater risk of breast cancer (HR, 1.67; 95% CI, 1.52-1.84)
• 64% greater risk of genitourinary tract cancer (HR, 1.64; 95% CI, 1.48-1.81)
• 52% greater risk of male genital organ cancer (HR, 1.52; 95% CI, 1.40-1.66)

“The particularly high incidence of oropharyngeal carcinoma in heart failure patients suggests that common extrinsic risk factors such as nicotine are a possible trigger of the comorbidity,” the authors wrote.

When speculating on possible reasons for the link between heart failure and cancer incidence, the authors hypothesized roles of chronic inflammation or increased free radical formation and that heart failure may promote tumor growth due to upregulation of certain proteins, with animal studies suggesting SerpinA3 and A1, fibronectin, ceruloplasmin, and paraoxonase 1.

They stated that further study is necessary “to clarify this relationship” they saw, both to better protect patients with heart failure and to improve their cancer prognosis, with a special focus on intensified tumor screening.

Reference

Roderburg C, Loosen SH, Jahn JK, et al. Heart failure is associated with an increased incidence of cancer diagnoses. ESC Heart Fail. Published online June 28, 2021. doi:10.1002/ehf2.13421