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The association between heart failure and incident cancer in women: An analysis of the Women’s Health Initiative

Doug J Leedy 1Kerryn W Reding 2 3Alexi L Vasbinder 2Garnet L Anderson 3Ana Barac 4Jean Wactawski-Wende 5Aladdin H Shadyab 6Charles B Eaton 7Wayne C Levy 1LiHong Qi 8Richard K Cheng 1

Eur J Heart Fail. 2021 May 1.doi: 10.1002/ejhf.2207. 


Aims: There is conflicting evidence whether heart failure (HF) is a risk factor for incident cancer. Despite population-based cohorts demonstrating this association, an analysis of the Physician’s Health Study found no association in a cohort of mostly healthy males. We investigated the association of HF with incident cancer among a large cohort of post-menopausal women.

Methods and results: A prospective cohort study of 146,817 post-menopausal women age 50 to 79 years enrolled in the Women’s Health Initiative from 1993-1998, and followed through 2015. The primary exposure was adjudicated incident HF diagnosis, including preserved and reduced ejection fraction in a subcohort. The primary outcome was adjudicated incident total and site-specific cancers. Hazard ratios were calculated using multivariable-adjusted Cox proportional hazard regression models. Over a median follow-up of 8.4 years, 3,272 and 17,474 women developed HF and cancer, respectively. HF developed in 235 women prior to cancer. HF was associated with subsequent incident cancer (hazard ratio [HR], 1.28; 95% confidence interval [CI], 1.11-1.48). Associations were observed for obesity-related cancers (HR 1.24 [95% CI, 1.02-1.51]), as well as lung and colorectal cancers (HR 1.58 [95% CI, 1.31-2.30], 1.52 [95% CI, 1.02-2.27], respectively). HF with preserved ejection fraction (HFpEF) (HR 1.34 [95% CI, 1.06-1.67]), but not HF reduced ejection fraction (HFrEF) (HR 0.99 [95% CI 0.74-1.34]), was associated with total cancer.

Conclusion: HF was associated with an increase in cancer diagnoses in post-menopausal women. This association was strongest for lung cancer. Further research is needed to appreciate the underlying mechanisms responsible for this association.