Likelihood of Cancer Diagnosis Jumps After Recognition of Heart Failure

November 07, 2012

LOS ANGELES — The risk of a new cancer diagnosis jumped a significant 68% in patients with newly identified heart failure compared with people without heart failure in a case-control study that adjusted for a range of comorbidities and cancer risk factors [1]. The risk of cancer showing up in an HF patient increased over time, and when it did, it was associated with a 48% increase in mortality.

The findings, based on patients seen primarily during the 1980s and 1990s, highlight the importance of noncardiac-disease illness in heart failure and, more important, the potential value of cancer surveillance as part of heart-failure management, according to the authors of the analysis, led by Dr Tal Hasin (Mayo Clinic, Rochester, MN), who presented it here at theAmerican Heart Association 2012 Scientific Sessions.

Dr Tal Hasin

Speaking with heartwire , Hasin speculated that heart failure and cancer in the same patient may share chronic inflammation as a pathophysiology, or they may have genetic triggers in common. Or it may be that something about heart failure itself or its treatment can precipitate malignancies.

He and his colleagues looked at the cancer history of 961 patients with newly diagnosed heart failure from 1979 to 2002 and an equal number of contemporary community-based age- and sex-matched controls. The HF patients were sicker, significantly more likely to have hypertension, diabetes, obesity, chronic obstructive pulmonary disease, peripheral vascular disease, and a history of smoking and acute MI. The HF patients and controls had histories of cancer at similar rates, 22% and 23%, respectively.

The group also followed 596 patients with a new HF diagnosis and no history of cancer, from the same span of years, and 596 contemporary non-HF patients who were matched for demographics and comorbidities.

Over a mean of 7.7 years, encompassing 9201 person-years of follow-up, 244 new cancer cases were identified. In a multivariate analysis, the hazard ratio for a new cancer diagnosis among HF patients compared with controls was 1.68 (95% CI 1.13–2.50) overall.

The imbalance in new cancer diagnoses appeared to concentrate among patients seen in later years, those presenting from 1991 to 2002: HR 1.86 (95% CI 1.10–3.15) for heart-failure cases vs controls. For those seen 1979 to 1990, the difference in incident cancer rate was nonsignificant at HR 1.48 (95% CI 0.79–2.78).

The heart-failure and cancer association wasn't significant for individual types of cancer, which included 48 cancers of the digestive system, 46 male-reproductive cancers, 39 hematologic malignancies, 24 breast cancers, 20 lung cancers, 19 urinary cancers, and others.

Hasin noted that the heart-failure and cancer association may simply be a matter of sharper detection: patients confronting a new heart-failure diagnosis see clinicians increasingly more often and tend to undergo a variety of new diagnostic evaluations over a short period of time. And that may simply unmask malignancies that would otherwise have gone undiagnosed.

However, those tests tend to closely follow a new HF diagnosis, Hasin observed, and the jump in cancer detection didn't start, on average, until about two years later.

Hasin had no disclosures.