Heart failure can increase cancer risk

A study in more than 200,000 individuals has found that patients with heart failure are more likely to develop cancer compared to their peers without heart failure. The research is presented today at Heart Failure 2021, an online scientific congress of the European Society of Cardiology (ESC),¹ and published in ESC Heart Failure, a journal of the ESC.²

This was an observational study and the results do not prove that heart failure causes cancer. However, the findings do suggest that heart failure patients may benefit from cancer prevention measures."

Dr. Mark Luedde, Study Author, Christian-Albrechts-University of Kiel and Cardiology Joint Practice Bremerhaven, Germany

Heart failure affects around 65 million people worldwide.³ Some patients with cancer develop heart failure as a consequence of cancer treatment.⁴ More recently it has also emerged that heart failure patients may have an elevated incidence of cancer during the course of their heart disease, but most studies have been small.^5-8

The current study investigated the association between heart failure and new cancer development in a large cohort. The study used information from the nationally representative Disease Analyser database, which covers 1,274 general practices in Germany.

A total of 100,124 patients with heart failure and 100,124 individuals without heart failure were
included in the analysis. Heart failure patients and those without heart failure were individually matched by sex, age, obesity, diabetes, and consultation frequency. No participants had cancer at the start of the study. Statistical models were used to examine the association between heart failure and the incidence of cancer over 10 years.

The average age of the study population was 72.6 years and 54% were women. During the 10 year observation period, the incidence of cancer was significantly higher among heart failure patients (25.7%) compared to those without heart failure (16.2%). In women, the incidence of cancer was 28.6% in patients with heart failure and 18.8% in those without heart failure. In men the corresponding rates were 23.2% and 13.8%.

Heart failure was significantly associated with the incidence of cancer, with a hazard ratio of 1.76. The hazard ratios for women and men were 1.85 and 1.69, respectively.

Significant associations were found between heart failure and all cancer types assessed. The greatest increase in risk was observed for cancer of the lip, oral cavity, and pharynx, with a hazard ratio of 2.10, followed by respiratory organ cancer, with a hazard ratio of 1.91. The hazard ratios for other sites were 1.86 for female genital organ cancer, 1.83 for skin tumours, 1.77 for lymphoid and haematopoietic tissue cancer, 1.75 for digestive tract cancer, 1.67 for breast cancer, 1.64 for genitourinary tract cancer, and 1.52 for male genital organ cancer.

Dr. Luedde said: "Our results allow us to speculate that there may be a causal relationship between heart failure and an increased rate of cancer. This is biologically plausible, as there is experimental evidence that factors secreted by the failing heart may stimulate tumour growth."⁷

He continued: "While heart failure and cancer share common risk factors such as obesity and diabetes, these were accounted for in the analysis by matching. It should be noted that our database does not include information on smoking, alcohol consumption or physical activity, so we were unable to match for these in the analysis."

Dr. Luedde concluded: "It is common practice for cancer patients who have received heart-damaging drugs to be monitored for heart failure. Conversely, evidence is accumulating to indicate that heart failure patients could benefit from intensive monitoring for cancer development - for example through screening. Considering the high incidence of both diseases and their impact of the lives of those affected, these patients deserve the maximum joint efforts of cardiologists and oncologists."