A recent French study has uncovered a concerning link between heart failure and a heightened susceptibility to developing cancer, specifically lung, colon, and blood cancers. The research indicates that this increased risk exists independently of other individual risk factors. According to data from the National Health Data system (SNDS), a considerable percentage of new cancer cases may be attributed to pre-existing heart failure.

The research team from the University Hospital Federation Prevent Heart Failure (European hospital Georges-Pompidou AP-HP, Inserm and Paris-cité University), publishing their findings in the European Journal of preventive Cardiology, suggests that « The results of this study call for a revision of clinical practices via better integration of oncological screening in the monitoring of patients who are insufficient cardiacs ».

Professor Jean-Sébastien Hulot, cardiologist and pharmacologist at the European Hospital Georges-Pompidou (Paris), and coordinator of PREVENT HEART FAILURE, notes that “Cancer and heart failure have risk factors and common pathogenic ways”. He adds, “In this context, we have also set up a cardio-oncology module which looks at the repercussions of cancer and anti-cancer treatments on the heart.”

The PR Hulot team’s interest in this connection was sparked by preclinical work led by Rudolf de Boer. Their animal experiments showed that heart transplantation in mice with heart failure increased the risk of cancer in a murine model predisposed to precancerous intestinal tumors. “The Dutch hypothesis was that the sick and tired heart secretes proliferative factors – like the serpina3 involved in cardiac remodeling – which could promote the growth of a tumor, Details the doctor. We wanted to verify this association in humans and specify which cancers could be concerned.”

Increased Mortality Risk

These two pathologies have risk factors and common pathogenic ways

The study analyzed data from 330,867 French adult patients hospitalized for a first episode of heart failure between 2010 and 2019 (average age at diagnosis: 77.7 years), comparing them with three control subjects without heart failure or pre-existing cancer. The heart failure patients were more likely to suffer from ischemic heart disease,high blood pressure,renal failure,diabetes,or obesity,with 41.1% having a left ventricular ejection fraction (FEVG) of less than 50%. Tobacco or alcohol consumption was similar in both groups.

After an average follow-up of 4.3 years, the annual cancer incidence in the heart failure group was 21.9 per 1,000 person-years, compared to 17.4 in the control group. This increased risk remained significant after adjusting for age, sex, alcohol and tobacco consumption, place of residence, and major comorbidities (HR = 1.07). “Although the association persists after adjustment, we cannot rule out the fact that these comorbidities can have an additional role in the occurrence of cancer”, Comments Professor Jean-Sébastien Hulot.

Regarding cancer types, the heart failure group showed 14% breast cancer in women, 13.7% colon cancer, and 8.7% lung cancer, compared to 14% breast cancer, 12.3% colon cancer, and 6.1% lung cancer in the control group. The increased incidence was more pronounced for lung cancer (HR = 1.42),colorectal cancer (HR = 1.22), and blood cancers (HR = 1.22), particularly multiple myeloma. Furthermore, heart failure patients who developed cancer had a higher risk of death compared to cancer patients without heart failure (HR = 1.33). While the researchers estimate that 16.5% of new cancer cases are attributable to heart failure in these patients, they emphasize that a direct causal link has not been established.

potential Explanations

Researchers have proposed two main hypotheses to explain the potential link between heart failure and cancer. “The first joins the experimental hypothesis of the Dutch. Especially since there are markers shared between cancer and heart failure, which can indicate common biological paths “, describes Professor Jean-Sébastien Hulot.

The second hypothesis is genetic.“The acquisition, with aging, of somatic mutations – clonal hematopoiesis of indefinite meaning, called chip – gives birth to lines of mutated white blood cells associated with cardiovascular risk, including the CI, but also to the risk of blood cancer. In these patients, there could be dysimmunity which would first manifest itself by an IC then by cancer, he continues. This hypothesis would be particularly relevant with the strong signal that we find of multiple myeloma.”

Implications for Screening and Monitoring

“Our study made it possible to identify an association between the IC and a cancer overview. It is a new fact that encourages to think about integrating prevention and screening actions in monitoring cardiac insufficiencyinterpreter Pr hulot.Insufficient cardiac patients are already at high risk, even more if they develop cancer, this is a good reason to detect it quickly.

Managing heart failure patients who develop cancer will require careful consideration of the cardiotoxicity of cancer treatments and the cardiovascular burden of cancer itself. Beyond treatment, optimizing monitoring examinations used in cardiology, such as chest imaging and biological dosages, could improve early detection. “Imaging could systematically look for the presence of tumors and the dosage of oncogenic markers could be added to blood reports,among others “, concludes Pr Hulot.