Brian Schwartz1, Morten Schou2, Gunnar H Gislason3, Lars Køber4, Christian Torp-Pedersen5, Charlotte Andersson6. 1. Department of Medicine, Section of Internal Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA. Electronic address: brian.schwartz@bmc.org. 2. Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen University, Herlev, Denmark. 3. Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen University, Gentofte, Denmark; The Danish Heart Foundation, Copenhagen, Denmark. 4. The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. 5. Departments of Clinical Investigation and Cardiology, Nordsjaellands Hospital, Hillerød, Denmark; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark. 6. Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen University, Herlev, Denmark; Department of Medicine, Section of Cardiovascular Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA.
Abstract
BACKGROUND: Patients with heart failure (HF) may be at increased risks of cancer, but the magnitude of risk for various cancer subtypes is insufficiently investigated. METHOD: Using the Danish Nationwide administrative databases between 1997 and 2017, we estimated the prevalence, incidence and relative risk for all-cause cancer in new-diagnosed HF vs. age and sex-matched controls (up to 5 controls per HF case) before and after adjustment for comorbidities. RESULTS: Among the 167,633 people in the heart failure group and 837,126 individuals in the control group, there was a higher prevalence of several comorbidities, including cancer (17% vs. 10%) in the HF group; odds ratio 1.72 (1.70-1.75). Patients with heart failure also had higher cancer incidence (cancer incidence rate 3.02 [2.97-3.07] per 100 person-years), compared with controls (cancer incidence rate 1.89 [1.88-1.90]); hazards ratio 1.38 (1.36-1.40). However, after adjustment for comorbidities the increased risk of malignancy was greatly attenuated (hazards ratio 1.14 [1.12-1.16] for incident all-cause cancer) and dissipated altogether after additional adjustment for medications (multivariable adjusted hazards ratio 0.93 [0.91-0.96] for all-cause cancer). In a homogeneous cohort of patients with ischemic heart disease, the increased risk of all-cause cancer was only marginally increased after adjustment for baseline comorbidities (hazards ratio 1.05 [1.02-1.08]). CONCLUSION: Patients with heart failure had a slightly increased risk of various cancer subtypes, but the risks were mainly driven by comorbidities.
BACKGROUND:Patients with heart failure (HF) may be at increased risks of cancer, but the magnitude of risk for various cancer subtypes is insufficiently investigated. METHOD: Using the Danish Nationwide administrative databases between 1997 and 2017, we estimated the prevalence, incidence and relative risk for all-cause cancer in new-diagnosed HF vs. age and sex-matched controls (up to 5 controls per HF case) before and after adjustment for comorbidities. RESULTS: Among the 167,633 people in the heart failure group and 837,126 individuals in the control group, there was a higher prevalence of several comorbidities, including cancer (17% vs. 10%) in the HF group; odds ratio 1.72 (1.70-1.75). Patients with heart failure also had higher cancer incidence (cancer incidence rate 3.02 [2.97-3.07] per 100 person-years), compared with controls (cancer incidence rate 1.89 [1.88-1.90]); hazards ratio 1.38 (1.36-1.40). However, after adjustment for comorbidities the increased risk of malignancy was greatly attenuated (hazards ratio 1.14 [1.12-1.16] for incident all-cause cancer) and dissipated altogether after additional adjustment for medications (multivariable adjusted hazards ratio 0.93 [0.91-0.96] for all-cause cancer). In a homogeneous cohort of patients with ischemic heart disease, the increased risk of all-cause cancer was only marginally increased after adjustment for baseline comorbidities (hazards ratio 1.05 [1.02-1.08]). CONCLUSION:Patients with heart failure had a slightly increased risk of various cancer subtypes, but the risks were mainly driven by comorbidities.