First-time myocardial infarction (MI) survivors who develop heart failure (HF) may have a greater risk of developing cancer when compared to those without HF, according to a study published July 11 in the Journal of the American College of Cardiology.

Researchers examined records for 1,081 patients in Olmsted County, MN, who had their first MI between November 2002 and December 2010. Patient data was from the Rochester Epidemiological Project.

After an average of 4.9 years of follow up, 228 patients (21 percent) were diagnosed with HF and 28 of those patients (12.3 percent) developed cancer, compared to 8.2 percent of patients without HF who were diagnosed with cancer. The average time from first MI to cancer diagnosis was 2.8 years, with the most common cancers being respiratory, digestive and hematologic. The incidence of cancer was similar initially between those with and without HF, but after 1.5 years of follow up there were higher rates of cancer among patients with HF. An association between HF and cancer remained after adjusting for age, sex, comorbidities, smoking, BMI and diabetes.

The researchers also studied the influence of medication on cancer diagnosis and found that patients who developed HF after MI were prescribed the same medications at discharge as those who were not, leading to the conclusion that treatment for MI was not likely responsible for the higher rate of cancer in HF patients. The authors note that their findings are statistically significant, but a limitation of the study is the small sample size and number of events.

“Cancer constitutes an enormous burden to society, and both cancer and HF are well-known causes of increased mortality,” said Veronique Roger, MD, MPH, FACC, senior author of the study. “Our research suggests an association between both diseases, and it’s possible that as we learn more about how this connection works, we can prevent deaths. In the meantime, physicians should recognize this increased cancer risk for HF patients and follow guideline recommended surveillance and early detection practices.”

In a related editorial comment, Jyoti Malhotra, MD, MPH, and Paolo Boffetta, MD, MPH, explain that the study “raises some interesting questions about the role of shared risk factors and other sources of bias in patients with HF that may account for the observed association with cancer.” However moving forward, “more definite evidence is needed before recommendations for cancer prevention in this patient group can be developed,” they add. 

Keywords: Body Mass Index, Comorbidity, Diabetes Mellitus, Early Detection of Cancer, Heart Failure, Incidence, Myocardial Infarction, Neoplasms, Risk Factors, Sample Size, Smoking, Survivors, Cardiotoxicity

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