Cancer risks in heart failure patients: Insights from ischemic and non-ischemic cardiomyopathy

Background/Introduction The field of cardio-oncology has gained significant attention due to the increased occurrence of cardiovascular disease (CVD) in cancer patients. Conversely, reverse cardio-oncology examines the development of cancer in patients with CVD. Heart failure (HF), particularly ischemic cardiomyopathy (CMP), is associated with systemic inflammation and oxidative stress, which may contribute to cancer development. Purpose This study aimed to investigate (1) whether the risk of cancer is elevated in HF patients compared to the general population, and (2) whether the risk of cancer differs between ischemic and non-ischemic CMP. Methods Using the National Health Insurance Service database, HF patients free of cancer between 2007 and 2010 were identified. After 1:1 propensity score matching for age and sex, cancer risk in HF patients (n=58,408) was compared to the general population (n=58,408) using Cox regression analysis. A separate analysis compared cancer risk between ischemic CMP (n=14,446) and non-ischemic CMP (n=43,931). Results Overall cancer occurrence was similar between HF patients and the general population (HR 1.00, 95% CI 0.957–1.046, p=0.987). However, certain cancers were more frequent in HF patients: myeloid leukaemia (HR 1.614, 95% CI 1.053–2.474), renal cell carcinoma (HR 1.468, 95% CI 1.107–1.946, p=0.008), and bladder cancer (HR 1.405, 95% CI 1.080–1.828). Conversely, the risks of breast (HR 0.741, 95% CI 0.605–0.907), colon (HR 0.855, 95% CI 0.775–0.944), and gastric cancers (HR 0.867, 95% CI 0.778–0.966) were lower in HF patients. In ischemic CMP, the overall cancer risk was comparable to non-ischemic CMP (HR 0.97, 95% CI 0.896–1.051, p=0.455). However, ischemic CMP patients had significantly higher risks of non-Hodgkin lymphoma (HR 2.517, 95% CI 1.209–5.240) and multiple myeloma (HR 8.839, 95% CI 1.682–46.443). Conclusion(s) While the overall cancer risk in HF patients is similar to the general population, specific cancers, such as myeloid leukaemia, renal cell carcinoma, and bladder cancer, occur more frequently. Similarly, ischemic CMP is associated with increased risks of certain haematologic malignancies. These findings underscore the importance of tailored cancer surveillance strategies in HF patients, particularly those with ischemic CMP.