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No association found between HF, cancer risk in men
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Among male physicians, there is no association between HF and increased risk for cancer, according to new data published in the Journal of the American College of Cardiology.
“Heart failure and cancer commonly coexist and are among the leading causes of morbidity and mortality in the United States. Recently, three studies have suggested an increased risk of cancer among patients with HF,” Senthil Selvaraj, MD, MA, from the division of cardiology and department of medicine at the Hospital of the University of Pennsylvania, and colleagues wrote in the study background. “Such an association, if validated, has profound basic science and clinical implications, raising several questions regarding common mechanisms (vs. common risk factors) for disease, need for increased cancer screening of HF patients, new targets of HF therapeutics, and inclusion of cancer endpoints in HF trials.”
Selvaraj and colleagues analyzed a cohort composed of 28,341 participants from the Physicians’ Health Studies I and II (mean age at baseline, 55 years) to determine the association between HF and cancer incidence and cancer-specific mortality. All participants were male physicians free from HF and cancer at baseline.
Follow-up included annual health evaluations and determination of cancer and HF diagnoses.
The researchers performed multivariable-adjusted Cox models to assess the relationship between HF and cancer, modeling HF as a time-varying exposure in the primary analysis.
Among the participants, 1,420 developed HF.
During a median follow-up time of 19.9 years (interquartile range, 11-26.8), 7,363 participants developed cancer.
It was found that HF was not linked to cancer incidence in crude (HR = 0.92; 95% CI, 0.8-1.08) or multivariable-adjusted analysis (HR = 1.05; 95% CI, 0.86-1.29).
Additionally, there was no association found between HF and site-specific cancer incidence or cancer-specific mortality after multivariable adjustment. A landmark analysis did not change the results.
A related editorial from Paolo Boffetta, MD, MPH, from the Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, and Jyoti Malhotra, MD, MPH, from the Rutgers Cancer Institute of New Jersey, stated that the study is a good example of how science advances with respect to the understanding of mechanisms underlying disease processes when controlled experimental studies are not possible.
“Hypotheses generated and initially tested in small, retrospective studies have to be validated eventually in larger, well-designed, prospective studies to determine an association of causality,” they wrote. “Through their work, these investigators have highlighted that the association between HF and cancer risk reported by the other previous studies could likely have reflected shared risk factors between these two entities. However, more data are needed from larger studies to obtain conclusive answers to this question.” by Dave Quaile
Disclosures: Selvaraj and Boffetta report no relevant financial disclosures. Malhotra reports she serves on the advisory boards of AstraZeneca and Pfizer. Please see the study for all other authors’ relevant financial disclosures.
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