AF risk elevated among patients with cancer; degree depends on cancer type
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Patients with cancer have elevated risk for atrial fibrillation development, although the degree varies by cancer type, researchers reported in JACC: CardioOncology.
“There is a paucity of information regarding the association between cancer type and risk of AF,” Jun Pil Yun, MD, from the department of internal medicine at Seoul National University Hospital, South Korea, and colleagues wrote. “Cancer is a heterogenous disease and the impact of cancer on AF risk may vary depending on the cancer type.”
The study enrolled 816,811 patients (mean age, 58 years; 47% men) with cancer from the Korean National Health Insurance Service database from 2009 to 2016. Researchers identified those newly diagnosed AF and stratified patients based on the type of cancer each had. Those with cancer were compared with 1,633,663 participants without cancer matched for age and sex.
There were 25,356 patients with cancer diagnosed with AF during a median follow-up of 4.5 years (6.6 per 1,000 person years). Researchers observed cancer as an independent risk factor for incident AF (adjusted HR = 1.63; 95% CI, 1.61-1.66) in a multivariable regression analysis.
Specifically, esophageal cancer demonstrated the highest risk for incident AF among solid cancers (aHR = 2.69; 95% CI, 2.45-2.95) and multiple myeloma had the strongest association with incident AF among all cancer types (aHR = 3.34; 95% CI, 2.98-3.75). The lowest risk for incident AF was observed among patients with stomach cancer (aHR = 1.27; 95% CI, 1.23-1.32). In addition, all hematologic malignancies such as lymphoma (aHR = 2.29; 95% CI, 2.1-2.51) and leukemia (aHR = 2.64; 95% CI, 2.38-2.92) were associated with high risk for AF development.
Researchers also observed high risk for AF development among intrathoracic malignancies in solid cancers, including lung cancer (aHR = 2.39; 95% CI, 2.3-2.48) and central nervous system cancer (aHR = 2.62; 95% CI, 2.35-2.91).
In an accompanying editorial, Konstantinos C. Siontis, MD, cardiac electrophysiologist and assistant professor of medicine at Mayo Clinic in Rochester, Minnesota, and colleagues noted that the finding that cancer-associated risk for AF was highest in the first 90 days after cancer diagnosis may reflect increased opportunities for incidental diagnoses of unrecognized AF during health care visits occurring after new cancer diagnoses.
It is also increasingly pressing to fill the gaps in evidence surrounding the pathogenesis of AF and optimal screening and management for the disease, according to Siontis and colleagues.
“The coexistence of cancer and AF will be an increasing problem owing to the aging population and improved survival of cancer patients thanks to ever-improving antineoplastic strategies,” Siontis and colleagues wrote. “This and other studies highlight the complex link between cancer and AF.”
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