Heart failure during acute coronary syndrome and the long-term risk of incident cancer. the abc-9*study on heart disease

Abstract Introduction Recent reports have suggested a higher risk of incident cancer among patients with pre–existing Heart failure (HF) in community–based cohorts. Methods To investigate the association between heart failure (HF) during hospitalization with acute coronary syndrome (ACS) and the very long–term cancer risk, we enrolled 572 patients admitted with ACS to 3 Italian hospitals and discharged alive and free from neoplasia. Patients were prospectively followed for 24 years or until death. Results All except for three patients completed the follow–up, representing 6440 person–years. Patients‘ mean age was 66 ± 12 years and 70% were males. Baseline clinical HF was diagnosed in 192 (34%) patients. During follow–up, 129 patients (23%) developed cancer; of them, 103 with no HF [27% of patients without HF] and 26 had baseline HF [14% of patients with HF]. The incidence rates for cancer were 18 and 21 per 1000 person–years for patients with and without baseline HF, respectively (p = 0.62). The risks for cancer associated with HF were (HR: 0.96; 95% CI: 0.62–1.47; p=0.85). Similar associations were observed among both genders and in patients younger than 75 years of age. Yet, in patients older than 75 years, the unadjusted risk was (HR: 0.30; 95% CI: 0.09–0.92; p=0.04). However, the fully adjusted risk was (HR: 0.39; 95% CI: 0.12–1.30; p=0.13). The unadjusted HRs for incident cancer were (HR: 0.88; 95% CI: 0.45–1.74; p=0.73) and (HR: 0.91; 95% CI: 0.48–1.71; p=0.77) for patients with HFrEF and HFpEF respectively. We observed a positive interaction between age and LVEF for the risk of cancer onset (HR: 1.002; 95% CI: 1.003 –1.004; p=0.02) in the unadjusted model. Results were the same in the fully adjusted model. Conclusions A lack of association between clinical HF at admission for ACS and the long–term cancer risk has been observed in this prospective study of unselected ACS patients. A positive independent interaction between age and LVEF has been also observed.