Patients with heart failure (HF) may be at increased risk for cancer and cancer-related mortality, according to findings from a community-based cohort study published in JACC: CardioOncology.

For the study, researchers sourced data from anonymized administrative healthcare records from inhabitants (approximately 4 million) of Puglia, Italy. Individuals aged 50 years or older between 2005 and 2013, who had no history of cancer, were assessed for cancer onset and cancer-related mortality on the basis of HF status. Cases of individuals with HF (n=104,020) were matched with HF-free controls (n=104,020).

The HF and control cohorts included 46.8% and 46.8% men; 85.8% and 80.0% had hypertension; 38.5% and 24.5% dyslipidemia; and 31.3% and 28.0% diabetes, respectively. Among both cohorts, 28,664 were aged younger than 70 years, 35,078 aged 70-79 years, and 40,278 aged 80 years or older.

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A total of 12,036 and 7045 new diagnoses of cancer were identified among the HF and control cohorts during a median follow-up of 5 (IQR, 3.1-8.0) years, respectively. The incidence rate of cancer was 21.36 per 1000 person-years (py) among the HF cohort and 12.42 per 1000 py among the control group, indicating an increased risk for cancer among patients with HF (hazard ratio [HR], 1.76; 95% CI, 1.71-1.81).

Stratified by age, the HR for cancer among those with HF was 1.66 (95% CI, 1.58-1.75) for the cohort aged younger than 70 years, 1.69 (95% CI, 1.61-1.77) for those aged 70-79 years, and 2.07 (95% CI, 1.95-2.19) for the 80 years of age or older cohort.

Stratified by cancer type, HF associated with increased risk (all P <.001) for lung cancers (HR, 4.49), multiple myeloma (HR, 2.33), lymphoma (HR, 1.84), and colorectal cancers (HR, 1.46) and decreased risk for male reproductive cancers (HR, 0.90; P <.005).

Cancer-related deaths occurred among 4738 of the HF and 1208 of the control cohorts, equating to an increased risk for cancer-related mortality among the HF cohort (HR, 4.11; 95% CI, 3.86-4.38; P <.001). Stratified by age, the increased risk was more pronounced among those aged younger than 70 years (HR, 7.54; 95% CI, 6.33-8.98) compared with those aged 70-79 years (HR, 3.80; 95% CI, 3.44-4.19) or 80 years or older (HR, 3.10; 95% CI, 2.81-3.43).

Stratified by sex, both men (HR, 3.79; 95% CI, 3.51-4.10) and women (HR, 4.86; 95% CI, 4.35-5.43) with HF were at increased risk for cancer-related mortality.

For patients who used high-dose loop diuretics, implying more severe HF disease, both an increased risk for cancer incidence (HR, 1.11; 95% CI, 1.03-1.21) and cancer-related mortality (HR, 1.35; 95% CI, 1.19-1.53) were observed.

This study was limited by excluding individuals aged younger than 50 years. It remains unclear whether HF at younger ages associates with increased risk for cancer and cancer-related mortality.

“In this community-based cohort, individuals with HF had higher cancer incidence and mortality compared with matched control subjects,” the study authors wrote. “The excess risk applied to both [men] and [women], and virtually all types of solid and hematologic malignancies.”


Bertero E, Robusto F, Rulli E, et al. Cancer incidence and mortality according to pre-existing heart failure in a community-based cohort. JACC:CardioOncology. Published online January 18, 2022. doi:10.1016/j.jaccao.2021.11.007