Improvements in Cardiovascular and Thrombotic Risk Management Needed for Patients With MPN

Patients with myeloproliferative neoplasms (MPN) were not often prescribed appropriate medications to manage cardiovascular and thrombotic risk despite somewhat elevated rates of smoking and ischemic heart disease.

“These findings highlight a potential unmet need for improved cardiovascular risk management and coordination between primary and secondary care in the UK,” the study authors wrote in a poster presented at the 2021 European Hematology Association Virtual Congress.

In this international study, researchers assessed information from 2,477 patients with MPN (median age, 68 years; 56% women) to determine the potential cardiovascular and thrombotic risk for all patients with MPN. Patients were included in this database at their first recorded diagnosis of polycythemia vera (overproduction of blood cells in bone marrow; 1,315 patients), primary myelofibrosis (unusual blood cell production and scarring in bone marrow; 146 patients) and essential thrombocythemia (when the body produces too many platelets; 336 patients). Some patients also had unspecified MPN (680 patients).

Researchers focused on assessments of patients for six or more months before the first diagnosis and for at least 24 months after. During this time, researchers aimed to determine the risk patterns of polymorphonuclear leukocytes (a type of white blood cells), thrombotic/cardiovascular risk profiles before diagnosis, the extent of comorbidities and the occurrence of thromboembolic/cardiovascular events after diagnosis.

Most patients (96.2%) had a low comorbidity burden. Authors noted that polycythemia vera was the most prevalent MPN subtype, followed by essential thrombocythemia and myelofibrosis. The rates of polycythemia vera and myelofibrosis were consistent with other reports from the UK, but the prevalence of essential thrombocythemia was lower than previous reports.

The most prevalent risk factors before MPN diagnosis included smoking (59.8%) and ischemic heart disease (27.7%). In contrast, few patients had high blood pressure (14.6%), diabetes (13.1%), high lipid levels (12.8%) or obesity (8.8%). Patients with high blood pressure (88.9%), high lipid levels (82.4%) and diabetes (77.9%) were prescribed appropriate medications for risk management. Of all the patients with MPN in this study, there were 325 cases of thrombosis before diagnosis, with a mean time of thrombosis to MPN diagnosis of 3,100.8 days.

After MPN diagnosis, 372 thromboembolic/cardiovascular events occurred. In particular, 214 events were observed in patients with polycythemia vera, 64 events in those with essential thrombocythemia, nine events in patients with myelofibrosis and 85 events in those with unspecified MPN. Authors noted that the most frequent thromboembolic/cardiovascular events were stroke (27.2%), deep vein thrombosis (17.7%) and heart attack (14.8%). More patients with polycythemia vera had a heart attack (15.9%) compared with those with essential thrombocythemia (10.9%) or myelofibrosis (0%).

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