After experiencing their first myocardial infarction (MI), patients who later developed heart failure had an increased risk of cancer, according to research published in the Journal of the American College of Cardiology.

Tal Hasin, MD, of the Department of Cardiology at the Shaare Zedek Medical Center in Jerusalem, and colleagues evaluated the association between heart failure and risk of cancer among MI survivors. As they noted, heart failure is associated with excessive morbidity and mortality, and possibly with malignancy. . “Although usually considered a separate cause of morbidity, it may be that an association exists between heart disease and an increased risk of cancer,” the authors wrote.

To assess this relationship, researchers compared patients with heart failure in Olmsted County, Minnesota with community controls from 2002 to 2010. A total of 1081 individuals (mean age: 64 ± 15 years; 60% male) were followed for 5327 person-years (mean 4.9 ± 3.0 years). Over the course of follow-up, 228 patients developed heart failure and 98 patients developed cancer.


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The hazard ratio (HR) for cancer associated with heart failure was 2.16 (95% confidence interval [CI]: 1.39-3.35) and after adjustments for age, sex, and Charlson comorbidity index the HR was 1.71 (95% CI: 1.07-2.73). HRs for mortality associated with cancer were 4.90 (95% CI: 3.10-7.74) for heart failure-free patients and 3.91 (95% CI: 1.88-8.12) for patients with heart failure (P for interaction =.76).

“Patients with heart failure were 71% more likely to have subsequent cancer, adjusted for age, sex, and the Charlson comorbidity index,” the authors wrote. This trend was seemingly more apparent among patients with reduced ejection fraction.”

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They also added that the association between heart failure and cancer raises concerns over specific cardiovascular medications, including angiotensin-receptor blockers, cardiac glycosides, diuretic agents, statins, and prasugrel. However, patients who developed heart failure in this study did not differ by statins or angiotensin antagonists prescribed at the time of discharge for MI compared to patients who did not develop heart failure.

Regarding the more prevalent risk of cancer in patients with reduced ejection fraction, the authors noted this observation should be interpreted as “hypothesis generating, rather than hypothesis testing” due to the complexity of pathways that may lead to altered healing and reduced ejection fraction post-MI.

“The current findings extend our previous reports of an elevated cancer risk after heart failure compared with controls, and calls for a better understanding of shared risk factors and underlying mechanisms,” researchers concluded.

Reference

Hasin 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(3):265-271. doi: 10.1016/j.jacc.2016.04.053.