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. 2025 Jan 15;2(3):100051.
doi: 10.1016/j.bvth.2025.100051. eCollection 2025 Aug.

Cardiovascular risk factors in myeloproliferative neoplasms: associations with survival and thrombotic outcomes

Joan How  1 , Orly Leiva  2 , Robert Redd  3 , Anna E Marneth  4 , Daniel J DeAngelo  5 , Christina M Dieli-Conwright  6 , Areej El-Jawahri  7 , Baransel Kamaz  1 , Chulwoo Kim  1 , R Coleman Lindsley  5 , Marlise Luskin  5 , Maximilian Stahl  5 , Mohammed Wazir  8 , Lachelle D Weeks  5 , Gabriela S Hobbs  7
Affiliations

Cardiovascular risk factors in myeloproliferative neoplasms: associations with survival and thrombotic outcomes

Joan How et al. Blood Vessel Thromb Hemost. .

Abstract

Cardiovascular risk factors (CVRFs) are important modifiers of thrombosis in patients with essential thrombocythemia (ET), polycythemia vera (PV), and myelofibrosis (MF). We performed a retrospective cohort analysis evaluating CVRFs in 1005 patients with myeloproliferative neoplasms (MPNs) from the Dana-Farber Cancer Institute Hematologic Malignancies Data Repository from 2014 to 2023. We also included a non-MPN group of 1543 age- and sex-matched controls with no known diagnoses of hematologic malignancies to evaluate whether CVRFs differentially affected outcomes. CVRFs were identified through International Classification of Diseases codes for hypertension, hyperlipidemia, type 2 diabetes mellitus (DM2), current smoking, or body mass index ≥30 before MPN diagnosis. CVRFs occurred in 34% of patients with MPNs. Patients with MPN with ≥1 CVRF had increased risk of death (hazard ratio [HR], 2.52; 95% confidence interval [CI], 1.9-3.35) and arterial/venous thrombosis (HR, 3.05; 95% CI 2.39-3.92). Within MPN subtypes, patients with ET, PV, and MF who had CVRFs also demonstrated worse overall survival and thrombotic outcomes. Among CVRFs, only DM2 predicted worse thrombotic outcomes in patients with MPNs. The HR of CVRF on thrombosis was decreased in patients with MPNs compared with non-MPN controls (HR, 0.51; 95% CI, 0.36-0.86). Looking at ET, PV, and MF specifically, the presence of a CVRF also had less of an impact on thrombotic risk in ET compared with controls (HR, 0.35; P = .019); no interactions between MPN diagnosis and CVRFs were seen in patients with PV and MF. Our results underscore both the necessity of managing CVRFs in MPNs to improve patient morbidity and mortality and the need to ameliorate thrombotic risk with measures beyond addressing CVRFs.

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Conflict of interest statement

Conflict-of-interest disclosure: J.H. reports consultancy fees from PharmaEssentia and Merck. L.D.W. reports consultancy fees from AbbVie and Vertex; and membership on an entity's board of directors or advisory committees in Sobi. M.S. served on the advisory board for Novartis, Kymera, Sierra Oncology, GlaxoSmithKline, Rigel, Bristol Myers Squibb (BMS), Sobi, and Syndax; consulted for Boston Consulting and The Dedham Group; and participated in Continuing Medical Education activity for Novartis, Curis Oncology, Haymarket Media, and Clinical Care Options. D.J.D. reports honoraria from Pfizer, Incyte, Amgen, Takeda, Servier, Jazz, Kite, Blueprint, Autolus, Novartis, and Gilead; and research funding from AbbVie, Novartis, Blueprint, and GlycoMimetics. C.L. reports consultancy fees from Takeda Pharmaceuticals, bluebird bio, Qiagen, Sarepta Therapeutics, Verve Therapeutics, Jazz Pharmaceuticals, and Vertex Pharmaceuticals; and membership on an entity's board of directors or advisory committees in bluebird bio. M.L. reports research funding from AbbVie and Novartis; and honoraria from Jazz, Pfizer, Novartis, and Kite. A.E.-J. reports consulting fees from Incyte, Tuesday Health, Novartis, and GlaxoSmithKline. G.H. reports research funding from Incyte and MorphoSys; membership on an entity's board of directors or advisory committees in Keros, Pharmaxis, Pfizer, MorphoSys, Novartis, Protagonist, AbbVie, and BMS; and is a current holder of stock options in a privately held company in Regeneron. The remaining authors declare no competing financial interests.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
Outcomes in all MPN patients with or without a cardiovascular risk factor. The graphs show OS (A), thrombosis-free survival (B-D), MF-free survival (E), and leukemia-free survival (F) in patients with MPNs with or without a CVRF. NR, not reached.
Figure 2.
Figure 2.
Overall and thrombosis-free survival in MPN subtypes with or without a cardiovascular risk factor. The graphs show OS and thrombosis-free survival in patients with ET (A), PV (B), and MF (C) with or without a CVRF. NR, not reached.
Figure 2.
Figure 2.
Overall and thrombosis-free survival in MPN subtypes with or without a cardiovascular risk factor. The graphs show OS and thrombosis-free survival in patients with ET (A), PV (B), and MF (C) with or without a CVRF. NR, not reached.
Figure 3.
Figure 3.
Multivariable analysis of cardiovascular risk factors associated with overall survival. Multivariable analysis of CVRFs associated with OS in all MPNs (A), ET (B), PV (C), and MF (D) is shown.
Figure 3.
Figure 3.
Multivariable analysis of cardiovascular risk factors associated with overall survival. Multivariable analysis of CVRFs associated with OS in all MPNs (A), ET (B), PV (C), and MF (D) is shown.
Figure 4.
Figure 4.
Multivariable analysis of CVRFs associated with arterial and venous thrombosis. (A) All MPNs; (B) ET; (C) PV; (D) MF.
Figure 4.
Figure 4.
Multivariable analysis of CVRFs associated with arterial and venous thrombosis. (A) All MPNs; (B) ET; (C) PV; (D) MF.
Figure 5.
Figure 5.
Comparison of outcomes in MPN patients and non-MPN controls stratified by cardiovascular risk factors. The graphs show OS and thrombosis-free survival in patients with MPNs (A), ET (B), PV (C), and MF and non-MPN controls (D), stratified by presence of at least 1 CVRF. RHP, Rapid Heme Panel.
Figure 5.
Figure 5.
Comparison of outcomes in MPN patients and non-MPN controls stratified by cardiovascular risk factors. The graphs show OS and thrombosis-free survival in patients with MPNs (A), ET (B), PV (C), and MF and non-MPN controls (D), stratified by presence of at least 1 CVRF. RHP, Rapid Heme Panel.
See this image and copyright information in PMC

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