Do patients with heart failure have an increased risk of incident cancer compared to community controls?
Patients with heart failure have a significantly increased risk of developing incident cancer compared to matched community controls, which further increases their mortality risk.
To evaluate the risk of cancer in patients with heart failure (HF) compared to community controls and its impact on outcome. HF is associated with excess morbidity and mortality. Non-cardiac causes of adverse outcomes in HF are increasingly recognized but not fully characterized. In a case-control study, we compared history of cancer among community subjects newly diagnosed with HF from 1979–2002 to age-, sex-, and date-matched community controls without HF (961 pairs). Individuals without cancer at index (596 pairs) were followed for cancer in a cohort design, and the survival of HF patients who developed cancer was assessed. Before index, 22% of HF cases and 23% of controls had a history of cancer (odds ratio 0.94; 95% CI 0.75–1.17). During 9,203 person-years of follow-up mean (SD), 7.7 (6.4) years, 244 new cancer cases were identified; HF patients had a 68% higher risk of developing cancer hazard ratio (HR) 1.68; 95% CI 1.13–2.50 adjusted for body mass index, smoking and comorbidities. The HRs were similar for men and women with a trend toward a stronger association among subjects ≤75 years ( P =0.22) and during the most recent time period ( P =0.075). Among HF cases, incident cancer increased the risk of death (HR 1.56; 95% CI 1.22–1.99) adjusted for age, sex, year and comorbidities. HF patients are at increased risk of cancer, which appears to have increased over time. Cancer increases mortality in HF underscoring the importance of non-cardiac morbidity and of cancer surveillance in the management of HF patients. Keywords: heart failure, cancer, risk, epidemiology, follow-up studies
Hasin et al. (2013) studied this question.