Patients and survivors of hematological malignancies face substantially elevated short- and long-term risk of cardiovascular disease compared with the general population – with risk varying significantly by malignancy subtype, according to a population-based cohort study published April 8 in JACC.

The study analyzed 11 cardiovascular outcomes, including heart failure (HF), acute myocardial infarction (MI) and deep venous thrombosis, by matching 855,085 control participants 5:1 by age, sex and geographical area with 174,984 adults registered in the Netherlands Cancer Registry, who had been diagnosed between 1995 and 2023 with one of the 12 most common hematological malignancies.

Of the overall cohort, 12.7% had a history of cancer, of whom 13.2% had received prior chemotherapy. The most common malignancies were diffuse large B-cell lymphoma, multiple myeloma and chronic lymphocytic leukemia.

Results showed that the incidence of HF was elevated across all malignancy subtypes and varied widely, with the lowest incidence being 4.26 per 1,000 person-years in Hodgkin lymphoma and highest being 37.75 per 1,000 person-years in myelodysplastic syndrome and 24.68 per 1,000 person-years in multiple myeloma.

Additionally, the risk of venous thromboembolism remained elevated for five years across all malignancies, peaking in the first year with hazard ratios ranging from 3.52 in chronic lymphocytic leukemia to 34.04 in Hodgkin lymphoma.

Relative risks were most pronounced in younger patients (<70 years) who received cancer treatment, despite lower absolute event rates, highlighting the long-term cardiovascular burden in survivors.

Study authors Jesse Geels, MD, and colleagues highlight the heterogeneity of the results as a significant insight, noting that similar studies often lost the nuance between malignancy types by categorizing them into larger groups.

"This poses significant challenges for effective risk stratification, because these malignancies vary substantially in their biological characteristics, treatment protocols, and survival," they write. "The substantial variation in long-term [cardiovascular disease] risk across malignancy types underscores the need for [cardiovascular disease] risk prediction tools and targeted cardiovascular screening strategies for cancer survivors, accounting for malignancy subtype."

"Taken together, these findings challenge the notion that cardiovascular risk in hematologic malignancy is homogeneous," write Stephanie Wu, MD, FACC; June-Wha Rhee, MD; and Saro Armenian, DO, MPH; in an accompanying editorial comment. "Defining and testing subtype-informed and risk-adapted cardiovascular care pathways represents a critical next step in optimizing long-term outcomes for patients with hematologic malignancies."