Incident cancer in heart failure, myocardial infarction or both: a report from a global federated research network
M Camilli, N Girerd, P Ameri, F Ballacci, A Lombardo, K Duarte, G Baudry, D Rastogi, F Crea, G Savarese, L MonzoAbstract
Background
Heart failure (HF) and myocardial infarction (MI) may promote cancer development through common aetiological pathways. This study aims to investigate the mid-term risk of cancer in patients with HF or MI using a large, real-world dataset.
Methods
Adults with a first hospitalisation for acute HF or MI (AMI) between October 2015 and October 2024 were included from the TriNetX Global Collaborative Research Network. Each patient was matched 1:1 with controls without HF or AMI using propensity score matching (PSM). The primary endpoint was any new cancer diagnosis occurring during follow-up, starting 6 months after the index hospitalisation.
Results
Following PSM, the population included 120,783 HF patients and 7,896 AMI patients. After a median follow-up of 16 (IQR 0; 42) months for the HF cohort and of 16 (IQR 0; 40) months for the AMI cohort, both groups showed an increased risk of incident cancer compared to controls (HF: HR 2.80 [95% CI, 2.69-2.91], p<0.001; AMI: HR 2.02 [95% CI, 1.71-2.39], p<0.001). The risk was higher for hematologic than for solid malignancies for both HF (HR: 6.78 vs. 2.53) and AMI (HR: 4.45 vs. 1.77). HF with preserved ejection fraction (HFpEF) was associated with higher cancer incidence than HF with reduced or mildly reduced ejection fraction (HR 1.10 [95% CI, 1.04-1.17], p=0.002), while no difference was observed between ST and non-ST elevation AMI subtypes.
Conclusion
In a large real-world cohort, both HF and MI were associated with increased cancer incidence, especially hematologic malignancies. The association was most pronounced in HFpEF.For image description, please refer to the figure legend and surrounding text.