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Cancer in patients with heart failure: Incidence, risk factors and prognostic impact

  • Marta Sagastagoitia-Fornie
    Affiliations
    Servicio de Cardiología, Hospital Universitario Arquitecto Marcide, Ferrol (A Coruña), Spain
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  • Eduardo Barge-Caballero
    Correspondence
    Corresponding author at: Unidad de Insuficiencia Cardiaca y Trasplante. Servicio de Cardiología. Complejo Hospitalario Universitario de A Coruña (CHUAC). As Xubias, 84, CP 15006, A Coruña, Spain.
    Affiliations
    Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain

    Grupo de Investigación Cardiovascular (GRINCAR), Universidad de A Coruña (UDC), A Coruña, Spain

    Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
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  • Gonzalo Barge-Caballero
    Affiliations
    Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain

    Grupo de Investigación Cardiovascular (GRINCAR), Universidad de A Coruña (UDC), A Coruña, Spain

    Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
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  • David Couto-Mallón
    Affiliations
    Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain

    Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
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  • María J. Paniagua-Martín
    Affiliations
    Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain

    Grupo de Investigación Cardiovascular (GRINCAR), Universidad de A Coruña (UDC), A Coruña, Spain

    Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
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  • Daniel Enríquez-Vázquez
    Affiliations
    Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain
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  • Paula Blanco-Canosa
    Affiliations
    Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain

    Grupo de Investigación Cardiovascular (GRINCAR), Universidad de A Coruña (UDC), A Coruña, Spain

    Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
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  • Zulaika Grille-Cancela
    Affiliations
    Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain

    Grupo de Investigación Cardiovascular (GRINCAR), Universidad de A Coruña (UDC), A Coruña, Spain

    Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
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  • Manuel Jiménez-Navarro
    Affiliations
    Facultad de Medicina, Universidad de Málaga, Málaga, Spain
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  • Javier Muñiz
    Affiliations
    Grupo de Investigación Cardiovascular (GRINCAR), Universidad de A Coruña (UDC), A Coruña, Spain

    Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
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  • José M. Vázquez-Rodríguez
    Affiliations
    Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain

    Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
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  • María G. Crespo-Leiro
    Affiliations
    Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain

    Grupo de Investigación Cardiovascular (GRINCAR), Universidad de A Coruña (UDC), A Coruña, Spain

    Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
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Published:September 18, 2022DOI:https://doi.org/10.1016/j.ejim.2022.09.008

      Highlights

      • Cancer incidence and cancer-related mortality of patients with heart failure are higher than those expected for the general population.
      • Increased sympathetic activity, renin-angiotensin-aldosterone system activation, chronic inflammation and oxidative stress are proposed biological mechanisms to explain the increased risk of cancer in patients with heart failure.
      • Prognosis of patients with heart failure and co-existing malignancies is poor, with mortality rates that exceed 40% during the first year after cancer diagnosis.

      Abstract

      Aims

      To assess the incidence of cancer diagnosis and cancer-related mortality in patients with heart failure (HF).

      Methods

      Observational study based in a prospective cohort of patients with HF referred to a specialized Spanish clinic between 2010 and 2019. The observed incidence of malignancies (excluding non-melanoma skin cancer) was compared to that expected for the general Spanish population according to the Global Cancer Observatory.

      Results

      We studied 1909 consecutive patients with HF. Over a median follow-up of 4.07 years, 165 new cases of malignancy were diagnosed. Observed age-standardized incidence rates of cancer were 861 (95% CI 618.4–2159.4) cases per 100,000 patients-years in men and 728.5 (95% CI 451.1–4308.7) cases per 100,000 patients-years in women; while age-standardized incidence rates of cancer expected for the general Spanish population were 479.4 cases per 100,000 patients-years in men (risk ratio = 1.80) and 295.5 cases per 100,000 patients-years in women (risk ratio = 2.46). Both a history of pre-existing malignancy at baseline and the development of new malignancies during follow-up were associated with reduced survival. Observed age-standardized cancer-related mortality was 344.1 (95% CI 202.1–1675) deaths per 100,000 patient-years in men and 217.0 (95% CI 32.8–3949.3) deaths per 100,000 patient-years in women; while age-standardized cancer-related mortality expected for the general Spanish population was 201.4 deaths per 100,000 patients-years in men (risk ratio = 1.71) and 96.2 deaths per 100,000 patients-years in women (risk ratio = 2.26).

      Conclusion

      Patients with HF showed higher incidence rates of cancer diagnosis and cancer-related mortality than those expected for the general population.

      Graphical abstract

      Abbreviations:

      ACE (Angiotensin converter enzyme.), CI (Confidence Interval.), HF (Heart Failure.), HR (Hazard-Ratio.), IR (Incidence Rate), LVEF (Left Ventricular Ejection Fraction), NYHA (New York Heart Association)
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