News | Cardiac Diagnostics | July 21, 2016

Heart Failure After Heart Attack May Cause Cancer

Latest study finds 12.3 percent of patients diagnosed with heart failure after heart attack developed cancer

heart failure, after first heart attack, cancer risk, JACC study

July 21, 2016 — People who develop heart failure after their first heart attack have a greater risk of developing cancer when compared to first-time heart attack survivors without heart failure, according to a recent study in the Journal of the American College of Cardiology.

Heart failure refers to a number of conditions that can affect the heart’s structure and the way the heart works and, over time, make it harder for the heart to pump enough blood and oxygen to meet the body’s needs. It is associated with a higher risk of death than other types of heart disease.

Death from heart failure can often be attributed to direct cardiac causes such as heart failure symptoms, inadequate blood supply and irregular heartbeats; however, the noncardiac causes of heart failure death, such as cancer, are becoming increasingly recognized as researchers learn more about their association with the disease.

While cancer is usually considered a separate cause of death from heart disease, studies have been conducted to determine an association between heart disease and an increased cancer risk. This group of researchers previously looked at increased risk of cancer among heart failure patients and showed a 70 percent increase in risk.

In this new study, they looked at cancer risk in patients who developed heart failure after their first heart attack. Researchers chose to compare those with and without heart failure after heart attack because these patient groups have a lot in common, including atherosclerosis, risk factors, treatments received and follow-up routines. The factors that may differ between the groups, such as older age, obesity, smoking and diabetes, are known and can be controlled for, providing for comparison groups that may provide more information on the impact of heart failure on subsequent cancer occurrence than other heart disease groups.

Researchers looked at records for 1,081 patients in Olmsted County, Minn., who had their first heart attack 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, or 21 percent, were diagnosed with heart failure and 28 of those patients, or 12.3 percent, developed cancer. In comparison, 8.2 percent of patients without heart failure were diagnosed with cancer. The average time from first heart attack to cancer diagnosis was 2.8 years, with the most common cancers being respiratory, digestive and hematologic.

The analysis showed that the incidence of cancer was similar initially between those with and without heart failure, but after 1.5 years of follow-up there were higher rates of cancer among patients with heart failure. An association between heart failure and cancer remained after adjusting for age, sex, comorbidities, smoking, BMI and diabetes.

The findings are statistically significant, but a limitation of the study is the small sample size and number of events. These findings also support the earlier study that showed a 70 percent increased risk of cancer among heart failure patients.

Researchers looked at whether the increased incidence of cancer in heart failure patients could be due to the more frequent doctor visits and diagnostic procedures that occur with heart failure patients, which could lead to cancer being diagnosed earlier or at all. However, the researchers determined that since most healthcare demands of heart failure patients occur early after diagnosis, and most cancers were diagnosed after 1.5 years, this detection bias was not a major reason for more instances of cancer diagnosis in heart failure patients.

The influence of medication on cancer diagnosis was also studied. Patients who developed heart failure after heart attack were prescribed the same medications at discharge as those who were not, so researchers concluded treatment for heart attack was not likely responsible for the higher rate of cancer in heart failure patients.

“Cancer constitutes an enormous burden to society, and both cancer and heart failure are well-known causes of increased mortality,” said Veronique Roger, M.D., senior author of the study and director of the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery in Rochester, Minn. “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 heart failure patients and follow guideline-recommended surveillance and early detection practices.”

In a related editorial comment, Paolo Boffetta, M.D., M.P.H., associate director for population sciences at The Tisch Cancer Institute and chief of the Division of Cancer Prevention and Control of the at Mount Sinai in New York, addressed whether the increased risk of cancer in this group of heart failure patients warranted additional screening beyond what was recommended for the general public. The two most prominent cancers were digestive and respiratory, for which routing screening tests are not available.

Boffetta also said the predominance of these two cancers suggests “a role of shared risk factors, as both heart failure and cancer are associated with smoking and alcohol.”

This study was supported by grants from the National Heart, Lung and Blood Institute and the National Institute on Aging. The authors of the study and the editorial comment have no disclosures to report.

For more information: content.onlinejacc.org

Related Content

U.S. Soldiers Have Worse Heart Health Than Civilians
News | Cardiac Diagnostics | June 06, 2019
Active duty Army personnel have worse cardiovascular health compared to people of similar ages in the civilian...
Late Dinner and No Breakfast Worsens Outcomes After Heart Attack
News | Cardiac Diagnostics | May 23, 2019
People who skip breakfast and eat dinner near bedtime have worse outcomes after a heart attack, according to research...
HRS Releases New Expert Consensus Statement on Arrhythmogenic Cardiomyopathy
News | Cardiac Diagnostics | May 14, 2019
The Heart Rhythm Society (HRS) released a first-of-its-kind consensus statement with guidance on the evaluation and...
New Best Practices Help Manage Heart Attack Patients Without Significant Signs
News | Cardiac Diagnostics | April 15, 2019
For the first time in the United States, doctors with the American Heart Association (AHA) have outlined best practices...
The most recent U.S. Food and Drug Administration (FDA) clearance was Siemens Healthineers high-sensitivity troponin I assays (TnIH) for the Atellica IM and ADVIA Centaur XP/XPT in vitro diagnostic analyzers. The test helps in the early diagnosis of myocardial infarctions without the need for serial tropic testing. The time to first results is 10 minutes.

The most recent U.S. Food and Drug Administration (FDA) clearance was Siemens Healthineers high-sensitivity troponin I assays (TnIH) for the Atellica IM and ADVIA Centaur XP/XPT in vitro diagnostic analyzers. The test helps in the early diagnosis of myocardial infarctions without the need for serial tropic testing. The time to first results is 10 minutes. 

Feature | Cardiac Diagnostics | March 22, 2019 | Linda C. Rogers, Ph.D.
Troponins are a family of proteins found in skeletal and heart (cardiac) muscle fibers that produce muscular contract
ACC/AHA Update Guidance for Preventing Heart Disease; Stroke
Feature | Cardiac Diagnostics | March 18, 2019
The choices we make every day can have a lasting effect on our heart and vascular health. Adopting a heart healthy...
AHA Statement Warns Hookah Smoking May Harm the Heart
News | Cardiac Diagnostics | March 08, 2019
Smoking tobacco in waterpipes, more commonly known as hookahs, results in inhaling toxic chemicals, often at levels...
PTSD Alone Does Not Increase Heart Disease Risk in Veterans
News | Cardiac Diagnostics | February 20, 2019
February 20, 2019 — Post-traumatic stress disorder (PTSD) by itself does not explain the...
Hormone Therapy May Increase Cardiovascular Risk During Gender Transition
News | Cardiac Diagnostics | February 18, 2019
Patients receiving hormone therapy as part of their gender-transition treatment had an elevated risk for cardiovascular...
Overlay Init