Study Finds a Link Between Heart Failure and Cancer

A new study suggests that heart failure may be associated with an increased risk of cancer. The findings were published in ESC Heart Failure.

Despite advances in therapy, the mortality rate of heart failure patients remains high; and for these patients, the prognosis is heavily impacted by multiple comorbidities – such as cancer – a cooccurrence that has received special attention in recent years.

Researchers of this study sought to elucidate the theory that there may be an increased incidence of cancer in heart failure patients.

In this large-scale retrospective study, researchers assessed cancer incidences in failure patients at well over 1,200 general practices in Germany between January 2000 and December 2018 using Hazard regression models. In total, they analyzed 100,124 patients with heart failure and 100,124 patients without heart failure.

According to the results, following a 10-year observation period, over a quarter of patients (25.7%) with heart failure had been diagnosed with cancer, compared with just 16.2% of patients without heart failure. The researchers noted that heart failure was significantly associated with the incidence of cancer [hazard ratio (HR)=95% confidence interval, 1.76, 1.71–1.81; P < 0.001 in total; HR=1.85, 95% CI, 1.77–1.92, P < 0.001 in women; HR=1.69, 95% CI, 1.63–1.76, P < 0.001 in men].

Moreover, researchers observed a notable link between heart failure and specific cancer sites; and found the strongest associated between heart failure and cancer of the lip, oral cavity, and pharynx (HR=2.10, 95% CI, 1.66–2.17; P < 0.001), followed by respiratory organs (HR=1.91, 1.74–2.10; P < 0.001) and genital organs in women (HR=1.86, 1.56–2.17; P < 0.001).

“This was an observational study and the results do not prove that heart failure causes cancer,” said author Dr. Mark Luedde of the Christian-Albrechts-University of Kiel and Cardiology Joint Practice Bremerhaven, Germany via a press release. “However, the findings do suggest that heart failure patients may benefit from cancer prevention measures.”

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The study was subject to several limitations. For one, the ICD-10 coding system used in analysis might lead to misclassification and undercoding of certain diagnoses. For example, the researchers wrote, “we cannot distinguish between heart failure with reduced pump function and heart failure with preserved pump function in our database.”

Also, the study lacked data on socio-economic status (i.e., education and income) and lifestyle-related risk factors (i.e., smoking, alcohol consumption, and physical activity).

The researchers noted that their study was not the first to report the connection between heart disease and cancer; however, they emphasize that the large scale data on a cohort of over 200,000 ensures robust scientific reliability in the findings.

“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,” Dr. Luedde added.

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.”

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