Heart failure linked with an increased risk of cancer

Patients with heart failure appear to be at greater risk for developing cancer according to a new study that appears in ESC Heart Failure.1 Led by Christoph Roderburg, MD, professor of medicine at the Clinic for Gastroenterology, Hepatology, and Infectious Diseases at the University Hospital Düsseldorf in Germany, the retrospective cohort study assessed the incidence of cancer in patients with an initial diagnosis of heart failure and a matched non–heart failure cohort in 1274 general practices in Germany between January 2000 and December 2018. All patients were cancer-free at the beginning of the study. There were 100,124 patients with heart failure and 100,124 controls. The 2 groups were matched for several factors known to affect the risk of cancer, including age, sex, obesity, and the incidence of diabetes. Within the observation period, 25.7% of the patients with heart failure and 16.2% of the patients without heart failure had been diagnosed with cancer (P < .001). Heart failure was significantly associated with the incidence of cancer in total (HR, 1.76; 95% CI, 1.71-1.81; P < .001), in women (HR, 1.85; 95% CI, 1.77-1.92; P < .001), and in men (HR, 1.69; 95% CI, 1.63-1.76; P < .001). The increased cancer rate has been found in other studies, but the large number of patients in this study permitted researchers to determine differences in types of cancers. The strongest association was observed for lip, oral cavity, and pharynx cancers (HR, 2.10; 95% CI, 1.66-2.17; P < .001), followed by cancers of respiratory organs (HR, 1.91; 95% CI, 1.74-2.10; P < .001) and genital organs for female patients (HR, 1.86; 95% CI, 1.56-2.17; P < .001). The association was 1.83 (95% CI, 1.72-1.94; P < .001) for skin tumors, 1.77 (95% CI, 1.63-1.91; P < .001) for cancers of lymphoid and hematopoietic tissue, 1.75 (95% CI, 1.64-1.87; P < .001) for cancers of the digestive tract, 1.67 (95% CI, 1.52-1.84; P < .001) for breast cancer, 1.64 (95% CI, 1.48-1.81; P < .001) for cancers of the genitourinary tract, and 1.52 (95% CI, 1.40-1.66; P < .001) for male genital organ cancer. “More intensive screening for cancer may be warranted in patients with heart failure, particularly since new therapies have substantially improved the expected survival for patients with heart failure when applied,” says Gregg Fonarow, MD, interim chief of the Division of Cardiology at the University of California Los Angeles Medical Center, when asked to comment on the study.