Patients with heart failure have an increased risk of incident cancer

Tal Hasin, Yariv Gerber, Sheila M. McNallan, Susan A. Weston, Sudhir S. Kushwaha, Timothy J Nelson, James R Cerhan, Veronique Lee Roger

Research output: Contribution to journalArticle

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Abstract

Objectives This study sought to evaluate the risk of cancer in patients with heart failure (HF) compared with community controls and to determine the impact of cancer post-HF on outcomes. Background HF is associated with excess morbidity and mortality. Noncardiac causes of adverse outcomes in HF are increasingly recognized, but not fully characterized. Methods In a case-control study, we compared the history of cancer among community subjects newly diagnosed with HF from 1979 to 2002 to age-, sex-, and date-matched community controls without HF (961 pairs). Individuals without cancer at the index date (596 pairs) were followed for cancer in a cohort design, and the survival of HF patients who developed cancer was assessed. Results Before the index date, 22% of HF cases and 23% of controls had a history of cancer (odds ratio [OR]: 0.94; 95% confidence interval [CI]: 0.75 to 1.17). During 9,203 person-years of follow-up (7.7 ± 6.4 years), 244 new cancer cases were identified; HF patients had a 68% higher risk of developing cancer (hazard ratio [HR]: 1.68; 95% CI: 1.13 to 2.50) adjusted for body mass index, smoking, and comorbidities. The HRs were similar for men and women, with a trend toward a stronger association among subjects ≤75 years of age (p = 0.22) and during the most recent time period (p = 0.075). Among HF cases, incident cancer increased the risk of death (HR: 1.56; 95% CI: 1.22 to 1.99) adjusted for age, sex, index year, and comorbidities. Conclusions HF patients are at increased risk of cancer, which appears to have increased over time. Cancer increases mortality in HF, underscoring the importance of noncardiac morbidity and of cancer surveillance in the management of HF patients.

Original languageEnglish (US)
Pages (from-to)881-886
Number of pages6
JournalJournal of the American College of Cardiology
Volume62
Issue number10
DOIs
StatePublished - Sep 3 2013

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Heart Failure
Neoplasms
Confidence Intervals
Comorbidity
Morbidity
Mortality
Case-Control Studies
Body Mass Index
Smoking
History
Odds Ratio
Survival

Keywords

  • cancer
  • epidemiology
  • follow-up studies
  • heart failure
  • risk

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Patients with heart failure have an increased risk of incident cancer. / Hasin, Tal; Gerber, Yariv; McNallan, Sheila M.; Weston, Susan A.; Kushwaha, Sudhir S.; Nelson, Timothy J; Cerhan, James R; Roger, Veronique Lee.

In: Journal of the American College of Cardiology, Vol. 62, No. 10, 03.09.2013, p. 881-886.

Research output: Contribution to journalArticle

Hasin, Tal ; Gerber, Yariv ; McNallan, Sheila M. ; Weston, Susan A. ; Kushwaha, Sudhir S. ; Nelson, Timothy J ; Cerhan, James R ; Roger, Veronique Lee. / Patients with heart failure have an increased risk of incident cancer. In: Journal of the American College of Cardiology. 2013 ; Vol. 62, No. 10. pp. 881-886.
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title = "Patients with heart failure have an increased risk of incident cancer",
abstract = "Objectives This study sought to evaluate the risk of cancer in patients with heart failure (HF) compared with community controls and to determine the impact of cancer post-HF on outcomes. Background HF is associated with excess morbidity and mortality. Noncardiac causes of adverse outcomes in HF are increasingly recognized, but not fully characterized. Methods In a case-control study, we compared the history of cancer among community subjects newly diagnosed with HF from 1979 to 2002 to age-, sex-, and date-matched community controls without HF (961 pairs). Individuals without cancer at the index date (596 pairs) were followed for cancer in a cohort design, and the survival of HF patients who developed cancer was assessed. Results Before the index date, 22{\%} of HF cases and 23{\%} of controls had a history of cancer (odds ratio [OR]: 0.94; 95{\%} confidence interval [CI]: 0.75 to 1.17). During 9,203 person-years of follow-up (7.7 ± 6.4 years), 244 new cancer cases were identified; HF patients had a 68{\%} higher risk of developing cancer (hazard ratio [HR]: 1.68; 95{\%} CI: 1.13 to 2.50) adjusted for body mass index, smoking, and comorbidities. The HRs were similar for men and women, with a trend toward a stronger association among subjects ≤75 years of age (p = 0.22) and during the most recent time period (p = 0.075). Among HF cases, incident cancer increased the risk of death (HR: 1.56; 95{\%} CI: 1.22 to 1.99) adjusted for age, sex, index year, and comorbidities. Conclusions HF patients are at increased risk of cancer, which appears to have increased over time. Cancer increases mortality in HF, underscoring the importance of noncardiac morbidity and of cancer surveillance in the management of HF patients.",
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T1 - Patients with heart failure have an increased risk of incident cancer

AU - Hasin, Tal

AU - Gerber, Yariv

AU - McNallan, Sheila M.

AU - Weston, Susan A.

AU - Kushwaha, Sudhir S.

AU - Nelson, Timothy J

AU - Cerhan, James R

AU - Roger, Veronique Lee

PY - 2013/9/3

Y1 - 2013/9/3

N2 - Objectives This study sought to evaluate the risk of cancer in patients with heart failure (HF) compared with community controls and to determine the impact of cancer post-HF on outcomes. Background HF is associated with excess morbidity and mortality. Noncardiac causes of adverse outcomes in HF are increasingly recognized, but not fully characterized. Methods In a case-control study, we compared the history of cancer among community subjects newly diagnosed with HF from 1979 to 2002 to age-, sex-, and date-matched community controls without HF (961 pairs). Individuals without cancer at the index date (596 pairs) were followed for cancer in a cohort design, and the survival of HF patients who developed cancer was assessed. Results Before the index date, 22% of HF cases and 23% of controls had a history of cancer (odds ratio [OR]: 0.94; 95% confidence interval [CI]: 0.75 to 1.17). During 9,203 person-years of follow-up (7.7 ± 6.4 years), 244 new cancer cases were identified; HF patients had a 68% higher risk of developing cancer (hazard ratio [HR]: 1.68; 95% CI: 1.13 to 2.50) adjusted for body mass index, smoking, and comorbidities. The HRs were similar for men and women, with a trend toward a stronger association among subjects ≤75 years of age (p = 0.22) and during the most recent time period (p = 0.075). Among HF cases, incident cancer increased the risk of death (HR: 1.56; 95% CI: 1.22 to 1.99) adjusted for age, sex, index year, and comorbidities. Conclusions HF patients are at increased risk of cancer, which appears to have increased over time. Cancer increases mortality in HF, underscoring the importance of noncardiac morbidity and of cancer surveillance in the management of HF patients.

AB - Objectives This study sought to evaluate the risk of cancer in patients with heart failure (HF) compared with community controls and to determine the impact of cancer post-HF on outcomes. Background HF is associated with excess morbidity and mortality. Noncardiac causes of adverse outcomes in HF are increasingly recognized, but not fully characterized. Methods In a case-control study, we compared the history of cancer among community subjects newly diagnosed with HF from 1979 to 2002 to age-, sex-, and date-matched community controls without HF (961 pairs). Individuals without cancer at the index date (596 pairs) were followed for cancer in a cohort design, and the survival of HF patients who developed cancer was assessed. Results Before the index date, 22% of HF cases and 23% of controls had a history of cancer (odds ratio [OR]: 0.94; 95% confidence interval [CI]: 0.75 to 1.17). During 9,203 person-years of follow-up (7.7 ± 6.4 years), 244 new cancer cases were identified; HF patients had a 68% higher risk of developing cancer (hazard ratio [HR]: 1.68; 95% CI: 1.13 to 2.50) adjusted for body mass index, smoking, and comorbidities. The HRs were similar for men and women, with a trend toward a stronger association among subjects ≤75 years of age (p = 0.22) and during the most recent time period (p = 0.075). Among HF cases, incident cancer increased the risk of death (HR: 1.56; 95% CI: 1.22 to 1.99) adjusted for age, sex, index year, and comorbidities. Conclusions HF patients are at increased risk of cancer, which appears to have increased over time. Cancer increases mortality in HF, underscoring the importance of noncardiac morbidity and of cancer surveillance in the management of HF patients.

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KW - epidemiology

KW - follow-up studies

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KW - risk

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