Heart Failure After Myocardial Infarction Is Associated With Increased Risk of Cancer

Abstract

Background Heart failure (HF) is associated with excess morbidity and mortality for which noncardiac causes are increasingly recognized. We previously described an increased risk of cancer among HF patients compared with community controls. Objectives In the present study, we examined whether HF was associated with an increased risk of subsequent cancer among a homogenous population of first myocardial infarction (MI) survivors. Methods A prospective cohort study was conducted among Olmsted County, Minnesota residents with incident MI from 2002 to 2010. Patients with prior cancer or HF diagnoses were excluded. Results A total of 1,081 participants (mean age: 64 ± 15 years; 60% male) were followed for 5,327 person-years (mean: 4.9 ± 3.0 years). A total of 228 patients developed HF and 98 patients developed cancer (excluding nonmelanoma skin cancer). Incidence density rates for cancer diagnosis (per 1,000 person-years) were 33.7 for patients with HF and 15.6 for patients without HF (p = 0.002). The hazard ratio (HR) for cancer associated with HF was 2.16 (95% confidence interval [CI]: 1.39 to 3.35); adjusted for age, sex, and Charlson comorbidity index; HR: 1.71 (95% CI: 1.07 to 2.73). The HRs for mortality associated with cancer were 4.90 (3.10 to 7.74) for HF-free and 3.91 (1.88 to 8.12) for HF patients (p for interaction = 0.76). Conclusions Patients who develop HF after MI have an increased risk of cancer. This finding extends our previous report of an elevated cancer risk after HF compared with controls, and calls for a better understanding of shared risk factors and underlying mechanisms.

Incidence of new onset cancer in patients with a myocardial infarction – a nationwide cohort study

“…Based on our data, it is, however, difficult to explain the exact mechanism(s) why the association became insignificant after adjustment for comorbidities, but it may be speculated that environmental factors like tobacco and alcohol [ 25 ], unhealthy diet, shared genetic susceptibility, inflammation [ 26 , 27 ] and medication play a role, since these mechanisms are reflected in the confounders adjusted for in the analyses. Furthermore, a previous study observed an increased incidence of cancer after MI in patients with heart failure compared to those without heart failure after MI [ 28 ]. Thus, eliminating comorbidities may have eliminated the sicker patients more prone to post-MI heart failure.…”

Causes of Death in Patients with Severe Aortic Stenosis: An Observational study

“…Furthermore, low LVEF was related to non-cardiac death. Poor LV function is suggested to cause cardiac cachexia 20 and may affect systemic immunity 21 , 22 , which leads to non-cardiac deaths such as infection and malignancy. Atrial fibrillation is associated with an increased incidence of cerebrovascular death 23 .…”

Incidence of cancers in patients with atherosclerotic cardiovascular diseases

“…Spoon DB, et al [5] reported an obvious change in the causes of death from cardiac to non-cardiac causes such as cancers, in patients successfully treated with coronary angioplasty for coronary artery diseases. The study by Hasin et al [6] also speculated that heart failure complicated by myocardial infarction is a possible risk for cancers even with a limitation regarding an irregular medical surveillance. Because the SHIP cohort study holds a continuous health survey system for all patients with CVD, we could serve a certain amount of confidence in our observations that a high incidence of cancers is present in patients with atherosclerotic CVD when compared with those with non-atherosclerotic CVD.…”

“…Worldwide surveillance of health statistics [1] , [2] and/or a large cohort study [3] has critically highlighted the indisputable fact that cardiovascular diseases (CVD), especially atherosclerotic CVD, and cancers are the two leading causes of death among non-communicable diseases irrespective of socioeconomic status. Recent epidemiological studies [4] , [5] , [6] also implied an incremental risk of death due to non-cardiac causes, especially attributable to cancer developments, during the long-term follow-up of patients with coronary artery diseases. Several scientific bodies addressing the pathogenesis of atherosclerotic CVD and/or cancers demonstrated a presence of common denominators such as the role of inflammation [7] , [8] , [9] , [10] , [11] , neovascularity [12] , [13] , epigenetics [14] , [15] , [16] , [17] , [18] , [19] , and lifestyle behaviors [20] , etc., to propose the possible association between both diseases.…”