Does heart failure increase the risk of incident cancer? A meta-analysis and systematic review
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Does heart failure increase the risk of incident cancer? A meta-analysis and systematic review Hanlai Zhang 1,2 & Yonghong Gao 2 & Liqin Wang 2 & Li Tian 1 & Na An 1,2 & Xinyu Yang 1,2 & Xinye Li 1,3 & Chao Tian 1,2 & Mengchen Yuan 1,2 & Xingjiang Xiong 1 & Nian Liu 4 & Hongcai Shang 2 & Yanwei Xing 1
# Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract Recently, several studies have demonstrated that heart failure (HF) may increase the risk of incident cancer. However, this association has not been statistically and systematically verified by any comprehensive pooled analyses. We performed a meta-analysis on cancer morbidity and co-mortality of adults with HF in a large sample size to explore the relationship between HF and the risk of developing cancer. From inception to April 2019, we searched PubMed and EMBASE for published relevant articles on patients with HF diagnosed with cancer afterwards, with reported outcomes of morbidity and mortality. Two investigators independently reviewed these included studies. Study data were independently extracted using predefined data extraction forms. Random and fixed-effects models were fit for the study duration. This analysis consisted of 4 cohort studies comprising 5,004,251 participants. The relative risk (RR) for incident cancer was 1.22 (95% confidence interval (CI), 1.13–1.33) indicating that patients with HF may have a higher risk of developing cancer. The pooled RR of co-mortality was 2.03 (95% CI, 1.13–3.65), indicating that HF associated with cancer increases the risk of mortality. In this meta-analysis and systematic review, our results demonstrated that heart failure may increase the risk of incident cancer and that HF associated with cancer increases the risk of mortality. Keywords Heart failure . Cancer morbidity . Mortality . Meta-analysis . Systematic review
Introduction Heart failure (HF) and cancer are two major contributors to the burden of mortality accounting for 45.4% of deaths worldwide [22, 26] and will indisputably increase as the population ages, and advanced treatments enhance longevity [13, 27, 28]. Hanlai Zhang and Yonghong Gao contributed equally to this work. * Hongcai Shang [email protected] * Yanwei Xing [email protected] 1
Guang’an men Hospital, China Academy of Chinese Medical Sciences, Beijing, China
2
Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
3
Beijing University of Chinese Medicine, Beijing, China
4
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
Although generally considered as two separate disease entities, HF and cancer commonly coexist, share similar pathological mechanisms, and possess various potential interactions. Cancer survivors carry a greater burden of cardiomyopathy and HF compared with the non-cancer population [26]. The use of cytotoxic chemotherapy, radiotherapy, molecular targeted therapies, and immune-m
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