Heart Failure Linked to Increased Cancer Risk, Study Findings

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People with heart failure may be at increased risk for cancer.

Cancer patients are often monitored for heart failure, as some cancer drugs can damage the heart. Now a new study suggests that heart failure patients who may live with the condition for years may benefit from being monitored for cancer.

The researchers used a German health database to monitor 100,124 patients with heart failure and compared them to the same number of controls without heart failure. All were initially cancer-free, and the scientists tracked the incidence of cancer over the next 10 years. The study appears in the ESC journal Heart Failure..

Despite the lack of data on socioeconomic status, smoking, alcohol consumption and physical activity, which are known to affect cancer risk, the researchers matched the two groups for age, sex, age, incidence of obesity and diabetes.

Still, 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 to 16.2 percent of those without.

An increased rate of cancer among heart patients has been found in other studies, but the large sample in this analysis allowed the researchers to note differences between cancer types. The risk of cancer of the lips, oral cavity and pharynx was more than doubled in patients with heart failure. The risk was 91 percent higher for lung cancer and other respiratory cancers, 86 percent for female genital cancers, and 83 percent for skin cancers. People with heart failure had a 75 percent higher risk for colon cancer, stomach cancer, and other cancers of the digestive tract. Women with heart failure have a 67 percent higher risk of breast cancer, and men have a 52 percent higher risk of genital cancer.

D., a senior cardiologist at UCLA’s David Geffen School of Medicine, who was not involved in the study. “I think this is an interesting retrospective cohort study,” said Girish L. Kalra. “The primary shortcoming of the study is that the database did not allow researchers to control for the single greatest risk for developing cancer and heart disease: smoking. Smoking may be a common topic in this study.”

Still, although the strong association with oropharyngeal and respiratory cancers suggests smoking may be one explanation, the association remained intact for a wide range of cancers. The study also controlled for other factors associated with various cancers, such as obesity, diabetes, and advancing age, as well as the frequency of medical consultations that can lead to increased cancer detection.

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 of heart disease, which occurs even before symptoms appear, also correlates with an increased risk of cancer. The researchers write that chronic inflammation may play a role in both heart failure and cancer. Alcohol use has also been linked to several cancers.

“There are more correlations between heart failure and cancer than common risk factors,” said senior author Mark Luedde, a cardiologist at the University of Kiel in Germany. “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 overstated.”

Kalra agreed. “Ultimately, the heart is a messenger for all health,” he said. “This study supports the idea that people with heart failure are a high-risk group and warrants our closest attention. As physicians, we need to make sure our heart patients are screened for cancer at the recommended time intervals. And we must continue to nag our smokers to quit.”

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