HF associated with elevated risk for head and neck, lung cancers
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Patients with HF had elevated risk for various cancer diagnoses vs. those without HF, especially cancers of the head and neck and respiratory organs.
The findings were presented at the European Society of Cardiology’s Heart Failure 2021 & World Congress on Acute Heart Failure and published in ESC Heart Failure.
“Our results allow us to speculate that there may be a causal relationship between heart failure and an increased rate of cancer. This is biologically plausible, as there is experimental evidence that factors secreted by the failing heart may stimulate tumor growth,” Mark Luedde, MD, from Christian-Albrechts-University of Kiel and Cardiology Joint Practice in Bremerhaven, Germany, said in a press release. “This was an observational study and the results do not prove that heart failure causes cancer. However, the findings do suggest that heart failure patients may benefit from cancer prevention measures.”
For this analysis, researchers included 100,124 patients with HF and 100,124 patients without HF at 1,274 general practices in Germany who were individually matched by sex, age, diabetes, obesity and yearly consultation frequency. Using data from the Disease Analyzer database from 2000 to 2018, researchers evaluated the association between HF and incidences of different cancers during 10 years of follow-up.
HF and subsequent cancer diagnosis
During the observation period, 25.7% of patients with HF were diagnosed with cancer (28.6% of women; 23.2% of men) while 16.2% of patients without HF were diagnosed with cancer (18.8% of women; 13.8% of men; log-rank P < .001).
According to the study, patients with HF experienced greater risk for cancer compared with those without HF (HR = 1.76; 95% CI, 1.71-1.81; P < .001; HR for women = 1.85; 95% CI, 1.77-1.92; P < .001; HR for men = 1.69; 95% CI, 1.63-1.76; P < .001).
The strongest associations between cancer and HF were between cancer of lip, oral cavity and pharynx (HR for HF vs. no HF = 2.1; 95% CI, 1.66-2.17; P < .001), followed by cancer of respiratory organs (HR = 1.91; 95% CI, 1.74-2.1; P < .001) and cancer of genital organs in women (HR = 1.86; 95% CI, 1.56-2.17; P < .001).
“The particularly high incidence of oropharyngeal carcinoma in heart failure patients suggests that common extrinsic risk factors such as nicotine are a possible trigger of the comorbidity,” the researchers wrote in the simultaneous publication. “In this regard, one limiting factor of our study is that our database does not provide data on nicotine use or alcohol consumption. In addition to these external risk factors, cancer in general and cardiovascular diseases share common risk factors such as obesity and diabetes. As our data are adjusted for these risk factors, our highly significant results cannot be explained by these factors alone.”
Other cancer diagnoses
Other cancers diagnoses associated with HF included:
- skin tumors (HR = 1.83; 95% CI, 1.72-1.94; P < .001);
- cancer of lymphoid and hematopoietic tissue (HR = 1.77; 95% CI, 1.63-1.91; P < .001);
- cancer of the digestive tract (HR = 1.75; 95% CI, 1.64-1.87; P < .001);
- breast cancer (HR = 1.67; 95% CI, 1.52-1.84; P < .001);
- cancer of the genitourinary tract (HR = 1.64; 95% CI, 1.48-1.81; P < .001); and
- genital organ cancer in men (HR = 1.52; 95% CI, 1.4-1.66; P < .001).
“It is common practice for cancer patients who have received heart-damaging drugs to be monitored for heart failure,” Luedde said in the release. “Conversely, evidence is accumulating to indicate that heart failure patients could benefit from intensive monitoring for cancer development — for example through screening. Considering the high incidence of both diseases and their impact of the lives of those affected, these patients deserve the maximum joint efforts of cardiologists and oncologists.”
Reference:
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Luedde M, et al. Heart failure and comorbidities. Presented at: Heart Failure 2021 & World Congress on Acute Heart Failure; June 29-July 1, 2021 (virtual meeting).
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