Heart Failure May Increase Cancer Risk

Patients with heart failure may have a significantly higher risk for cancer compared with those without heart failure.

Findings from this study were published in ESC Heart Failure and may demonstrate how cancer and heart failure may share similar risk factors.

“Heart failure patients, who are also affected by reduced life expectancy, are now living longer,” said Dr. Mark Luedde, from the cardiological group practice in Bremerhaven, Germany, in an interview with CURE. “They are also at greater risk from other chronic diseases. Cancer is certainly an important burden here. We believe that in addition to the other medical measures necessitated by heart failure, affected patients should also be screened for cancer more closely than unaffected people of comparable age.”

Recently, more focus has been placed on cardio-oncology, which includes both the cardiac-related side effects of antitumor therapies and the increased incidence of cancer in patients with heart failure, for example. To assess the association between cancer incidence and heart failure, researchers analyzed data from 100,124 patients (mean age, 73 years; 46% men) with heart failure and 100,124 patients (mean age, 73 years; 46% men) without heart failure who were treated in Germany between 2000 and 2018. Patients with heart failure were paired with those without heart failure based on age, sex, obesity, diabetes and annual frequency of visiting their doctor, which potentially aided in better assessment of the data.

“We would like to emphasize that our data are based on a very large cohort of (less than) 200,000 patients, which ensures the high scientific reliability of our results,” authors wrote. “This enabled us to provide a broad correlative picture of the association between heart failure and several tumor entities, while other studies have concentrated on single tumor entities only.”

During a 10-year period, cancer was diagnosed in 25.7% of patients with heart failure and in 16.2% of those without heart failure. In women who were diagnosed with cancer, 28.6% had heart failure and 18.8% did not. In contrast, 23.2% of men with heart failure and 13.8% of men without heart failure were diagnosed with cancer.

There was a significant association between heart failure and the incidence of cancer regardless of the specific cancer site. The strongest link between heart failure and cancer incidence was demonstrated in lip, pharynx and oral cavity cancers, followed by respiratory organs and genital organs in women.

“It is important to note here that our data show a statistical association and not a compelling causal link, but the association is so strong that a causal link can be naturally assumed,” Luedde said. “The particularly strong association of heart failure and cancer of the oropharyngeal and respiratory organs suggest common risk factors, for example, nicotine use. However, there is also discussion of heart failure’s own cancer-causing potential. For example, heart failure is also an inflammatory disease; an underlying inflammatory state of the body could promote (tumor growth). Various molecules that are produced in the failing heart and are also partially released into the blood act as oncogenes.”

Researchers also observed strong associations between heart failure and the incidence of skin tumors, cancer of hematopoietic and lymphoid tissue, breast cancer, cancer of the digestive tract and cancer of the genitourinary tract. The weakest association was seen for genital organ cancer in men, although it was still highly significant.

“Since we are still at the beginning of the research, (how patients with heart failure can potentially reduce their cancer risk) cannot be answered conclusively,” Luedde said. “Optimal drug therapy for heart failure is certainly a component. In addition, the age-appropriate cancer screening measures should be taken in any case. Another factor that can protect against both heart failure and cancer is the avoidance of risk factors such as nicotine, but above all, regular exercise. Every heart failure patient in stable condition should exercise. It has been well shown that this can also protect against cancer.”

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