Are patients with heart failure at risk of cancer?

By Rebecca Jenkins
Heart failure is associated with an increased incidence of cancer diagnoses, research suggests.

The retrospective cohort study assessed the incidence of cancer in 100,124 patients with an initial diagnosis of heart failure and a matched non-heart failure cohort of 100,124 patients.

Within the 10-year observational period, 25.7% of patients with heart failure had been diagnosed with cancer, compared with 16.2% of patients without heart failure, the German researchers reported in ESC Heart Failure.

A significant association was found between heart failure and all cancer sites assessed, but the strongest association was observed for cancer of the lip, oral cavity and pharynx.

Patients were matched individually by sex, age, diabetes, obesity and yearly consultation frequency, but there was no information available on socioeconomic status, or nicotine and alcohol use.

The data only showed a statistical relationship between heart failure and cancer, the researchers warned, but they speculated there could be a causal relationship.

‘One possible explanation could be the occurrence of certain pathomechanisms such as chronic inflammation or increased free radical formation, which may interact with a certain genetic background to connect both heart failure and cancer,’ they wrote.

‘Another interesting hypothesis suggests that heart failure is an oncogenic condition. This means that the failing heart may promote tumourigenesis or tumour growth.’

Cardiologist Associate Professor Aaron Sverdlov, Director of Heart Failure and Cardio-oncology at the University of Newcastle and Hunter Medical Research Institute, said another recent study presented compelling, albeit preclinical, evidence that heart failure promotes intestinal cancer growth in a mouse model (Circulation 2018; 138: 678-691).

‘Several putative mechanistic pathways have been suggested in that paper...however it is highly likely that multiple pathways would be involved in the complex pathogenesis of heart failure-cancer nexus,’ he told Medicine Today.

Cancer and heart failure were inter-related on many levels, he noted, sharing some of the same underlying pathophysiological mechanisms, including inflammation, abnormal metabolism and redox stress, and risk factors such as hypertension, obesity, diabetes and smoking.

To date the link between heart failure and subsequent development of cancer had been somewhat conflicting.

‘A few studies have suggested such a link, consistently reporting a higher risk of malignancy in subjects with heart failure than in non-heart failure controls,’ he said.

‘This finding may also in part be due to a surveillance bias, since active follow up of heart failure patients with regular visits may result in detection of tumours at an early stage, which is missed in the general population.’

Despite the compelling early experimental data showing a possible mechanistic link, it was too early to recommend dedicated cancer screening in heart failure patients, just because of the heart failure diagnosis.

‘It is however quite likely that in the near future we may indeed have more evidence to guide as to which heart failure patients may require closer cancer screening,’ he said.
ESC Heart Failure 2021; doi:10.1002/ehf2.13421.