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Review
. 2019 Dec;21(12):1515-1525.
doi: 10.1002/ejhf.1539. Epub 2019 Jul 18.

Cancer and heart disease: associations and relations

Rudolf A de Boer  1 , Wouter C Meijers  1 , Peter van der Meer  1 , Dirk J van Veldhuisen  1
Affiliations
Review

Cancer and heart disease: associations and relations

Rudolf A de Boer et al. Eur J Heart Fail. 2019 Dec.

Abstract

Emerging evidence supports that cancer incidence is increased in patients with cardiovascular (CV) disease and heart failure (HF), and patients with HF frequently die from cancer. Recently, data have been generated showing that circulating factors in relation to HF promote tumour growth and development in murine models, providing proof that a causal relationship exists between both diseases. Several common pathophysiological mechanisms linking HF to cancer exist, and include inflammation, neuro-hormonal activation, oxidative stress and a dysfunctional immune system. These shared mechanisms, in combination with risk factors, in concert may explain why patients with HF are prone to develop cancer. Investigating the new insights linking HF with cancer is rapidly becoming an exciting new field of research, and we herein review the most recent data. Besides insights in mechanisms, we call for clinical awareness, that is essential to optimize treatment strategies of patients having developed cancer with a history of HF. Finally, ongoing and future trials should strive for comprehensive phenotyping of both CV and cancer end points, to allow optimal usefulness of data, and to better describe and understand common characteristics of these two lethal diseases.

Keywords: Cancer; Cardio-oncology; Circulating factors; Heart failure.

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Figures

Figure 1
Figure 1
Non‐cardiovascular (CV) death accounted for ∼30% in the iPRESERVE and TOPCAT trials, enrolling patients with heart failure with preserved ejection fraction (HFpEF), and for 15% in the PARADIGM‐HF trials, enrolling patients with heart failure with reduced ejection fraction (HFrEF). In all trials, cancer was the dominant cause of non‐CV death, accounting for 35–40% of non‐CV deaths. Data shown for the: (A) Irbesartan in Heart Failure With Preserved Systolic Function (iPRESERVE); (B) Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist (TOPCAT); and (C) Prospective Comparison of ARNI with an ACE‐Inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure (PARADIGM‐HF).
Figure 2
Figure 2
Hypothesis of the interplay between cardiac‐derived proteins of a failing heart and cancer, and vice versa. Reproduced with permission from Richards.63
Figure 3
Figure 3
Cumulative incidence of cancer according to N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) tertiles. Reproduced with permission from Meijers et al.62
See this image and copyright information in PMC

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