Association between heart failure and the incidence of cancer: a systematic review and meta-analysis
Vikash Jaiswal, Song Peng Ang, Vibhor Agrawal, Maha Hameed, Marina Saleeb, Akash Jaiswal, Maitri Shah, Nicole Lao, Jia Ee Chia, Kusum Paudel, Alessia Gimelli, Jerome Zacks
Abstract
Abstract Aims The association between heart failure (HF) patients and the incidence of cancer is not well understood, with conflicting results to date. The aim of this meta-analysis was to evaluate whether patients with HF have a higher risk of developing cancer. Methods and results We performed a systematic literature search using PubMed, Embase, and Scopus for relevant articles from inception until 10 December 2022. The primary clinical outcome was the incidence of cancer. Secondary endpoints were the incidence of breast cancer, lung cancer, haematological cancer, colorectal cancer, and prostate cancer. A total of 9 articles with 7 329 706 (515 041 HF vs. 6 814 665 non-HF) patients were involved in the analysis. The mean age of the patients in the HF and the non-HF groups was 69.06 and 66.76 years. The median follow-up duration was 6.7 years. The most common comorbidity among both groups includes diabetes mellitus (27.58 vs. 14.49%) and hypertension (81.46 vs. 57.38%). Patients with HF were associated with a significant increase in the incidence of cancer {hazard ratio [HR], 1.43 [95% confidence interval (CI): 1.21–1.68], P < 0.001}, breast cancer [HR, 1.28 (95% CI: 1.09–1.50), P < 0.001], lung cancer [HR, 1.89 (95% CI: 1.25–2.85), P < 0.001], haematological cancer [HR, 1.63 (95% CI: 1.15–2.33), P = 0.01], and colorectal cancer [HR, 1.32 (95% CI: 1.11–1.57), P < 0.001] compared with patients without HF. However, the incidence of prostate cancer was comparable between both groups [HR, 0.97 (95% CI: 0.66–1.43), P = 0.88]. Conclusion This meta-analysis confirms that the state of HF is associated with a higher risk for incident cancer. These data may aid in raising awareness with physicians that cancer may develop in patients with prevalent heart failure and that early screening and evaluation may be useful in an early diagnosis of cancer.