Incident Cancer in Heart Failure Patients and the Need for Additional Investigations.

We read with interest the paper by Bertero et al, which evaluated the risk of cancer in heart failure (HF) patients. This study examined 104,020 patients aged >50 years in Italy over a 16-year time frame. The results indicated an increased incidence rate of cancer in HF patients compared with control subjects (hazard ratio [HR]: 1.76, 95% CI: 1.71-1.81). However, an important variable not considered in this study was ethnicity because the population was limited to 1 area of Italy.

The conclusion of this study is corroborated by Roderburg et al, in 2021, who found a similar association between HF and cancer (HR: 1.76 [95% CI: 1.71-1.81]; P < 0.001). However, the study by Roderburg et al evaluated additional cancer types and additional confounders, and found the strongest associations between HF and cancers of the pharynx, lip, and oral cavity (HR: 2.1 [95% CI: 1.66-2.17]; P < 0.001). HF was also associated with lung cancer and female gynecologic cancers (HR:1.91 [95% CI: 1.74-2.10] and 1.86 [95% CI: 1.56-2.17], respectively; P < 0.001). These cancer types warrant further investigation.

Leedy et al, in 2021, found a significant association between incident cancer in post-menopausal women aged 50 to 79 years with HF (HR: 1.28, 95% CI: 1.02-1.51) in lung, colorectal, and obesity-related cancers. Furthermore, there was an overall increased risk of incident cancer in patients with HF with preserved ejection fraction (HR: 1.34, 95% CI: 1.06-1.67). In future investigations, it will be important to incorporate various HF subtypes, and include men as well as younger patients.