Heart failure after first myocardial infarction linked to cancer


A study published in the Journal of the American College of Cardiology (JACC) indicates that patients who develop heart failure after their first myocardial infarction have a greater risk of developing cancer than those who do not develop heart failure after a first myocardial infarction. Senior author Veronique Roger (Mayo Clinic Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Rochester, USA) and others previously reported that heart failure patients had a 70% increased risk of developing cancer.

Roger et al looked at records for 1,081 patients in Olmsted County (USA) who had their first myocardial infarction between November 2002 and December 2010—patient data were from the Rochester Epidemiological Project. They focused on cancer risk in patients who developed heart failure after their myocardial infarction. After an average of 4.9 years of follow up, 228 patients (21%) were diagnosed with heart failure; 28 of these patients (12.3%) subsequently developed cancer compared with 8.2% of patients without heart failure who developed cancer. According to the authors, the average time from first myocardial infarction to cancer diagnosis was 2.8 years, with the most common cancers being respiratory, digestive and haematological.

The authors also found 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, body mass index and diabetes.

They 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 health care 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.

“Cancer constitutes an enormous burden to society, and both cancer and heart failure are well-known causes of increased mortality. Our research suggests an association between both diseases, and it is 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,” Roger comments.