Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jan 25;9(1):8.
doi: 10.1186/s40959-023-00158-1.

Cancer incidence and mortality in patients diagnosed with heart failure: results from an updated systematic review and meta-analysis

Massimiliano Camilli  1   2 , Juan Guido Chiabrando  3 , Marco Lombardi  4 , Marco Giuseppe Del Buono  4   5 , Rocco Antonio Montone  5 , Antonella Lombardo  4   5 , Filippo Crea  4   5 , Giorgio Minotti  6
Affiliations

Cancer incidence and mortality in patients diagnosed with heart failure: results from an updated systematic review and meta-analysis

Massimiliano Camilli et al. Cardiooncology. .

Abstract

Background: Several cohort studies aimed at demonstrating an increased risk of cancer incidence and mortality in patients with a pre-existing diagnosis of heart failure (HF); however, conflicting results have been reported that call for systematic review and meta-analysis.

Methods: We conducted a systematic search of multiple databases from their inception through July 2022 and retrieved only papers reporting hazard ratios (HR). Random and fixed-effects models were fit for the study duration.

Results: The analysis included nine cohort studies for a total of 515'041 HF cases and 1'365'452 controls without HF. Although high heterogeneity among studies was observed, the HR for incident cancer in HF patients was statistically significant (1.45, 95% CI 1.31-1.61, p < 0.0001), which was confirmed by sensitivity analyses; however, by analyzing the few papers reporting HRs for cancer mortality, no significant difference between HF and non-HF patients could be detected (HR 2.03, 95% CI [0.93-4.43], p = 0.0736). Further scrutiny of studies with adjusted HRs, when available, confirmed that cancer incidence was significantly increased in patients with HF, as was cancer mortality as well.

Conclusions: This meta-analysis shows that HF patients are at an increased risk of incident cancer. Increased mortality could not be firmly demonstrated by the available data. Our results call for inclusion of cancer-related endpoints in HF trials to adequately address this important clinical issue.

Keywords: Cancer incidence; Cancer mortality; Cardio-oncology; Heart failure; Meta-analysis; Systematic review.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Forest plots for the incidence of the primary and secondary outcomes. Panel A cancer incidence in patients with and without Heart Failure (HF). Panel B cancer mortality according to previous diagnosis of HF. Panel C-D sensitivity analysis evaluating cancer incidence and mortality excluding papers with gender restriction
Fig. 2
Fig. 2
Forest plots for the incidence of the primary outcome (Panel A) in analyses including only papers with matched 1:1 case-control design
Fig. 3
Fig. 3
Forest plots for the incidence of the primary and secondary outcomes using adjusted Hazard Ratios. Panel A cancer incidence in patients with and without Heart Failure (HF). Panel B cancer mortality according to previous diagnosis of HF
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. de Boer RA, Meijers WC, van der Meer P, van Veldhuisen DJ. Cancer and heart disease: associations and relations. Eur J Heart Fail. 2019;21:1515–1525. doi: 10.1002/ejhf.1539. - DOI - PMC - PubMed
    1. de Boer RA, Hulot JS, Tocchetti CG, Aboumsallem JP, Ameri P, Anker SD, et al. Common mechanistic pathways in cancer and heart failure. A scientific roadmap on behalf of the translational research Committee of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC) Eur J Heart Fail. 2020;22:2272–2289. doi: 10.1002/ejhf.2029. - DOI - PMC - PubMed
    1. Tocchetti CG, Ameri P, de Boer RA, D'Alessandra Y, Russo M, Sorriento D, et al. Cardiac dysfunction in cancer patients: beyond direct cardiomyocyte damage of anticancer drugs: novel cardio-oncology insights from the joint 2019 meeting of the ESC working groups of myocardial function and cellular biology of the heart. Cardiovasc Res. 2020;116:1820–1834. doi: 10.1093/cvr/cvaa222. - DOI - PubMed
    1. Adamo M, Gardner RS, McDonagh TA, Metra M. The ‘Ten Commandments’ of the 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2022;43(6):440–441. doi: 10.1093/eurheartj/ehab853. - DOI - PubMed
    1. Lyon AR, López-Fernández T, Couch LS, Asteggiano R, Aznar MC, Bergler-Klein J, et al. 2022 ESC guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the international cardio-oncology society (IC-OS) Eur Heart J. 2022;43:4229–4361. doi: 10.1093/eurheartj/ehac244. - DOI - PubMed

LinkOut - more resources