High prevalence of cardiovascular comorbidity in multiple myeloma. A Swedish register study with matched controls

Q: What are the key findings of this study?

Cardiovascular events at 2-year follow-up in multiple myeloma patients increased the risk of death compared to patients without events (HR 1.30, 95% CI 1.21-1.40, p<0.0001).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Multiple myeloma and cardiovascular comorbidity (n=43233). Intervention: Cardiovascular event at 2-year follow-up in multiple myeloma patients vs. Multiple myeloma patients without a cardiovascular event. Primary outcome: Risk of death in multiple myeloma patients with vs without a cardiovascular event at 2-year follow-up (HR 1.30, 95% CI 1.21-1.40, p=<0.0001).

Q: What does this research mean for the field?

Patients with multiple myeloma have a significantly higher baseline prevalence of cardiovascular disease and a higher incidence of subsequent cardiovascular events than matched controls, both of which are associated with increased mortality. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate cardiovascular comorbidity at diagnosis, 2-year incidence of cardiovascular events, and mortality risk in patients with multiple myeloma compared to matched controls.

Karin Larsson; Ingigerdur Sverrisdottir; Sigrun Einarsdottir; Moshtak Karma; Mariana Villegas-Scivetti; Dorota Knut‐Bojanowska; Gunnar Juliusson; Kristina Carlson; Gunnar Larfors; Cecilie Hveding Blimark

doi:10.21203/rs.3.rs-11072650/v1

October 11, 2026Open Access

High prevalence of cardiovascular comorbidity in multiple myeloma. A Swedish register study with matched controls

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Key result

Cardiovascular events in multiple myeloma patients linked to ~30% higher mortality risk at 2 years.

HR 1.30
95% CI 1.21-1.40
P<0.0001
n=43,233

Why the study?

Multiple myeloma has a median age at diagnosis of 72 years, making baseline cardiovascular comorbidity, incident cardiovascular events, and associated mortality risk relative to matched controls a clinical concern.

Does multiple myeloma increase the prevalence of baseline cardiovascular disease, incidence of 2-year cardiovascular events, and risk of mortality compared to matched population controls?

Key Points

To evaluate cardiovascular comorbidity at diagnosis, 2-year incidence of cardiovascular events, and mortality risk in patients with multiple myeloma compared to matched controls.
Nationwide population-based register study including 8,672 multiple myeloma patients diagnosed between 2008 and 2021 from the Swedish Myeloma Registry and 34,561 matched controls.
Cardiovascular disease and event diagnoses were collected from Swedish registries and evaluated using chi-square tests and Cox proportional hazards regression models.
At diagnosis, 45.8% of multiple myeloma patients had cardiovascular disease versus 35.7% of controls (p<0.0001), most frequently hypertension (32.5% vs 23.3%, p<0.0001) and atrial fibrillation (11.1% vs 9.1%, p<0.0001).
At 2-year follow-up, atrial fibrillation affected 17.7% of patients versus 8.5% of controls (p<0.0001) and 30.1% versus 17.7% in patients older than 80 years (p<0.0001), while 43% of patients without prior cardiovascular disease developed a new event.
Patients with a cardiovascular event at 2-year follow-up faced an increased risk of death compared to patients without an event (HR 1.30, 95% CI 1.21–1.40, p<0.0001).

Study Design

Type

Cohort (n=43,233)

Multicenter

Yes

Structured PICO

Does multiple myeloma increase the prevalence of baseline cardiovascular disease, incidence of 2-year cardiovascular events, and risk of mortality compared to matched population controls?

P

Population

8,672 multiple myeloma patients and 34,561 matched population controls (total N=43,233; median age 72 years, 42.6% female) in Sweden diagnosed between 2008 and 2021 and followed for a median of 3.1 to 5.7 years.

E

Exposure

Diagnosis of multiple myeloma and exposure to modern MM primary therapies (including immunomodulatory drugs, proteasome inhibitors, CD38 antibodies, high-dose melphalan, and autologous stem cell transplantation).

C

Comparator

Matched population controls (4 per MM patient, matched on sex, year of birth, and county of residence) without any preceding hematological malignancy at the time of matching date (n=34,561).

O

Outcome

Prevalence of cardiovascular disease (CVD) at the time of MM diagnosis (including diagnoses within 5 years prior), incidence of new-onset cardiovascular events (CVE) at 2-year follow-up, and all-cause and CVD-related risk of death.hard clinical

Main Result

Hazard Ratio: 1.3 (95% CI 1.21–1.4)

p-value: p=<0.0001

Patients with multiple myeloma have a substantially higher burden of baseline cardiovascular disease and 2-year new-onset cardiovascular events (especially hypertension and atrial fibrillation) compared to matched controls, which significantly worsens survival and highlights the need for dedicated cardio-oncology management guidelines.

Limitations

Retrospective register-based design
Potential influence of surveillance and registration bias (primary care/GP diagnoses not reported to the Patient Register)
Lack of data on subsequent treatment lines, specific regimens, cumulative steroid exposure, and concomitant AL amyloidosis
Survival analyses were not adjusted for renal disease, performance status, or disease severity
Residual confounding cannot be excluded and causality cannot be inferred
Known limitations in diagnostic accuracy of the Cause of Death Register among elderly patients with comorbidities
Potential influence of surveillance and registration bias (e.g., general practitioners do not report diagnoses to the Swedish Patient Register)
Lack of information on subsequent lines of therapy beyond first-line, specific treatment regimens, and cumulative steroid exposure
Lack of data on the presence of concomitant AL amyloidosis
Missing data on primary treatment for almost 5% of the patients

Implication

Cardiovascular events may warrant closer monitoring in multiple myeloma; extends prior AF observations but leaves causal interventions open.

Abstract

Introduction Multiple myeloma (MM) is a hematological malignancy with a median age at diagnosis of 72 years. Consequently, cardiovascular comorbidity is a concern. Using Swedish population-based registries, we aim to describe cardiac comorbidities among patients at time of MM diagnosis, the incidence of new cardiovascular events (CVE) at 2-year follow-up and the risk of death, in comparison with matched controls. Material and methods All MM patients (n=8 672) in the Swedish myeloma registry (SMR) diagnosed 2008-2021 were included. Matched controls (n=34 561) and data on cardiovascular disease (CVD) and CVE were collected from nationwide registries. Differences in incidence and mortality were evaluated with chi-square tests and Cox regression. Ethical consent was obtained from the Swedish Ethical Review Board. Results At time of MM diagnosis, 45.8% of the MM patients had a registered CVD vs 35.7% of the controls, p<0.0001. The most frequent comorbidities were hypertension and atrial fibrillation (AF) among both patients and controls; hypertension 32.5% vs 23.3%, p<0.0001 and AF 11.1% vs 9.1%, p<0.0001. At 2-year follow-up, 17.7% of patients had AF vs 8.5% of controls, p<0.0001. Occurrence of AF in patients >80 years was substantial, 30.1%, vs 17.7%, p<0.0001. Among patients with no prior CVD, new-onset CVE was seen among 43%. Patients with CVE at 2-year follow-up had an increased risk of death vs patients without a CVE, HR 1.30 (95% CI 1.21-1.40, p<0.0001). Conclusion Almost 50% of patients had a CVD at the time of MM diagnosis. Among patients >80 years, 30% had a diagnosis of AF at 2-year follow-up. Almost half of MM patients with no CVD at time of MM diagnosis, had a CVE at 2-year follow-up. Among MM patients, CVE was associated with inferior survival, calling for awareness and guidelines for management of CVD among MM patients.

Discussion

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Cite This Study

Larsson et al. (2026) conducted a cohort in Multiple myeloma and cardiovascular comorbidity (n=43,233). Cardiovascular event at 2-year follow-up in multiple myeloma patients vs. Multiple myeloma patients without a cardiovascular event was evaluated on Risk of death in multiple myeloma patients with vs without a cardiovascular event at 2-year follow-up (HR 1.30, 95% CI 1.21-1.40, p=<0.0001). Cardiovascular events at 2-year follow-up in multiple myeloma patients increased the risk of death compared to patients without events (HR 1.30, 95% CI 1.21-1.40, p<0.0001).

synapsesocial.com/papers/6ae682a3e432e7a5c4ef35de https://doi.org/10.21203/rs.3.rs-11072650/v1

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High prevalence of cardiovascular comorbidity in multiple myeloma. A Swedish register study with matched controls

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

High prevalence of cardiovascular comorbidity in multiple myeloma. A Swedish register study with matched controls

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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