Abstract 11697: Patients with Heart Failure have an Increased Risk of Cancer

Abstract

Background: Heart failure (HF) is associated with excess morbidity and mortality. Non-cardiac causes of adverse outcomes among patients with HF are increasingly recognized but not fully characterized.

Aim: To evaluate the risk of cancer in patients with HF compared to community controls and examine its impact on outcome.

Methods: In a case-control study we compared history of cancer among Olmsted County, Minnesota, residents newly diagnosed with HF in 1979-2002 with age- and sex-matched community controls without HF (961 pairs; mean age 75 years; 54% women). Pairs without prior history of cancer (596 pairs; mean age 73 years; 53% women) were then followed to evaluate their subsequent risk of cancer in a cohort study. Among HF patients, the association between cancer, modeled as a time-dependent covariate, and death was assessed.

Results: Patients diagnosed with HF had a higher prevalence of hypertension, diabetes, obesity, smoking, chronic obstructive pulmonary disease (COPD), prior myocardial infarction (MI) and peripheral vascular disease (PVD). Before the index date, 209 (22%) HF cases and 219 (23%) controls had any history of cancer [OR=0.94 (95% CI: 0.75-1.17)]. During 9,201 person-years of follow-up (mean [SD], 7.7 [6.4] years), 244 new cancer cases were identified (48 digestive system; 46 male reproductive; 39 hematologic; 24 breast; 20 respiratory; 19 urinary; 7 female reproductive; 7 skin; 34 other). Using stratified Cox models (baseline case/control pairs as strata), HF patients had a 57% higher risk of developing cancer (hazard ratio (HR)=1.57; 95% CI: 1.10-2.25) after adjustment for age, sex and year; unchanged after further adjustment for BMI, prior MI, hypertension, diabetes, smoking, PVD, dementia and COPD (HR=1.58; 95% CI: 1.01-2.47). The HRs were similar for men and women (p=0.68) but stronger among subjects <75 years (p=0.09). Among HF cases, incident cancer increased the risk of death (HR=1.46; 95% CI: 1.14-1.87) after adjustment for age, sex, year of HF and comorbidities.

Conclusion: Patients with HF are at increased risk of cancer, which confers an increased risk of death. These findings underscore the importance of non-cardiac morbidity in HF and raise the issue of primary and secondary cancer prevention efforts among HF patients.