The ABC Study on Heart Disease Foundation-ONLUS, Conegliano, Italy.
Department of Cardiology, Minia University, Minia, Egypt.
ESC Heart Fail. 2024 Jun;11(3):1389-1399. doi: 10.1002/ehf2.14668. Epub 2024 Feb 20.
A higher risk of cancer among patients with heart failure (HF) has been suggested in recent community-based studies. This study aimed to investigate the impact of HF during hospitalization with acute coronary syndrome (ACS) on the long-term cancer risk.
The study included 572 patients admitted with ACS to three Italian hospitals, discharged cancer-free, and prospectively followed for 24 years or until death. All but three patients completed the follow-up, which represented 6440 person-years (mean age: 66 ± 12 years; 70% males). Baseline HF was diagnosed in 192 (34%) patients. A total of 129 (23%) patients developed cancer (103 without HF and 26 with HF), and 107 (19%) patients died due to it (81 without HF and 26 with HF). The incidence rates for cancer onset and cancer death were not different according to HF status. Cox regression analysis revealed no association between HF or left ventricular ejection fraction (LVEF) and cancer risk. In addition, no difference in cancer risk was observed among patients with HF with preserved ejection fraction, HF with mildly reduced ejection fraction, and HF with reduced ejection fraction. In competing risk regression analysis, the risk of cancer onset associated with HF was sub-hazard ratio (SHR) 0.47 [95% confidence interval (CI): 0.30-0.72; P = 0.001] and SHR 1.02 (95% CI: 1.01-1.04; P = 0.002) with LVEF. Results were the same in the adjusted model. Yet the fully adjusted model showed an attenuated association between cancer death and HF (SHR: 0.63; 95% CI: 0.37-1.05; P = 0.08) and LVEF (SHR: 1.02; 95% CI: 0.99-1.06; P = 0.08). Consistent results were obtained after using propensity score matching analysis that created 192 pairs. A negative interaction between age and HF and a positive interaction between age and LVEF for cancer risk have also been found.
An inverse association between baseline HF and long-term cancer risk has been observed among the ABC Study on heart disease patients who were followed for 24 years after ACS.
最近的社区研究表明，心力衰竭（HF）患者患癌症的风险更高。本研究旨在探讨急性冠状动脉综合征（ACS）住院期间 HF 对长期癌症风险的影响。
该研究纳入了意大利三家医院收治的 572 名 ACS 患者，这些患者出院时未患有癌症，并进行了为期 24 年或直至死亡的前瞻性随访。除了 3 名患者外，所有患者均完成了随访，随访时间代表了 6440 人年（平均年龄：66±12 岁；70%为男性）。基线时有 192 名（34%）患者被诊断为 HF。共有 129 名（23%）患者发生癌症（103 名无 HF，26 名有 HF），107 名（19%）患者死于癌症（81 名无 HF，26 名有 HF）。根据 HF 状态，癌症发病和癌症死亡的发生率没有差异。Cox 回归分析显示 HF 或左心室射血分数（LVEF）与癌症风险之间没有关联。此外，射血分数保留型 HF、射血分数轻度降低型 HF 和射血分数降低型 HF 患者的癌症风险也没有差异。在竞争风险回归分析中，HF 相关的癌症发病风险比（SHR）为 0.47（95%CI：0.30-0.72；P=0.001），与 LVEF 的 SHR 为 1.02（95%CI：1.01-1.04；P=0.002）。调整模型的结果相同。然而，在完全调整的模型中，HF 与癌症死亡之间的关联减弱（SHR：0.63；95%CI：0.37-1.05；P=0.08）和 LVEF（SHR：1.02；95%CI：0.99-1.06；P=0.08）。使用倾向评分匹配分析创建 192 对后，也得到了一致的结果。还发现了年龄和 HF 之间的负交互作用以及年龄和 LVEF 之间的正交互作用与癌症风险之间的关系。
在 ACS 后随访 24 年的 ABC 心脏病患者中，观察到基线 HF 与长期癌症风险呈负相关。
