People with heart failure can be at increased risk of cancer.
Cancer patients are usually monitored for heart failure because some cancer drugs can damage the heart. Now, a new study suggests that heart failure patients who can live with the disease for many years could benefit from being monitored for cancer.
The researchers used a German health database to track 100,124 heart failure patients and compare them to the same number of controls who did not have heart failure. All were initially cancer-free, and the scientists tracked their cancer incidence over the next 10 years. The study is in the journal ESC Heart Failure.
The two groups were matched for age, gender, age, obesity, and diabetes incidence, although researchers lacked data on socioeconomic status, smoking, alcohol consumption, and physical activity, all of which are known to affect cancer risk.
Nevertheless, the differences in cancer incidence between the two groups were significant. Overall, 25.7 percent of patients with heart failure were diagnosed with some form of cancer compared with 16.2 percent in those without.
The increased rate of cancer in heart patients has been noted in other studies, but the large sample size in this analysis allowed researchers to identify differences between the cancers. Heart failure patients were more than twice as likely to develop cancer of the lip, oral cavity, and throat. The risk of lung cancer and other cancers of the respiratory tract was 91 percent higher, female genital cancer 86 percent, and skin cancer 83 percent higher. People with heart failure were 75 percent more likely to develop colon cancer, stomach cancer, and other cancers of the digestive system. Women with heart failure were 67 percent more likely to develop breast cancer and men were 52 percent more likely to develop cancer of the genital organs.
“I think it’s an interesting retrospective cohort study,” said Dr. Girish L. Kalra, Senior Cardiology Fellow at the David Geffen School of Medicine at UCLA who was not involved in the work. “The study’s main flaw is that the database did not allow researchers to control the greatest risk of developing cancer and heart disease: smoking. Smoking cigarettes could be the common thread in this study. “
Although the strong association with oropharyngeal and respiratory cancers suggests that smoking might be an explanation, the association remained robust for a wide range of cancers. The study also controlled other factors associated with different types of cancer, including obesity, diabetes, and increasing age, as well as the frequency of medical consultations that could lead to increased detection of cancer.
In addition to smoking, there are other possible mechanisms that could explain the link. For example, a previous study found that a well-known protein biomarker for heart disease that occurs before symptoms appear also correlates with an increased risk of cancer. It is also possible, the researchers write, that chronic inflammation can be implicated in both heart failure and cancer. Alcohol consumption has also been linked to a wide variety of cancers.
“There are more correlations between heart failure and cancer than just common risk factors,” says lead author Mark Luedde, a cardiologist at Kiel University. “Heart failure is not a heart disease. It is almost always a disease of the heart and other organs. The importance of comorbidities for the prognosis and quality of life of those affected cannot be overestimated. “
Dr. Kalra agreed. “Ultimately, the heart is a guarantee for all health,” he said. “This study supports the belief that people with heart failure are a high risk group and deserve our greatest attention. As doctors, we should ensure that our heart patients are screened for cancer at the recommended intervals. And we should continue to urge our smokers to quit. “