The association between pre-existing heart failure and cancer incidence: a systematic review and meta-analysis

Abstract

Cardiovascular diseases (CVD) and cancer represent some of the most recognized causes of mortality and comorbidity worldwide. Cancer is the second leading cause of death in heart Failure (HF) population. Recent studies brought the hypothesis that heart failure might promote development and progression of cancer. We aim to analyse and discuss the most recent evidence on the relationship between HF and cancer development. From inception to November 2022, we searched PubMed, WebofScience and ClinicalTrials.gov for relevant articles on patients with HF diagnosed with cancer subsequently, with reported outcomes of overall and site-specific cancer incidence and mortality. Of 2401 articles identified in our original search, 13 articles met our criteria. Studies reporting some risk rate estimates were summarized qualitatively. Studies reporting hazard ratios (HRs), or relative risks were combined in a meta-analysis, showing that HF was associated with an increased overall cancer incidence with a HR=1,30 (95%CI:1,04-1,62) compared with individuals without HF. Subgroup analyses by cancer type revealed increased risk for lung cancer (HR=1,87;95%CI:1,28-2,73), gastrointestinal cancer (HR=1,22;95%CI:1.03-1.45), haematologic cancer (HR=1,60;95%CI:1.23-2.08) and female reproductive cancer (HR=1,67;95%CI:1,27-2,21). The mortality by cancer was higher in HF patients compared with subjects without HF with a HR=2,17 (95%CI:1,23-3,84). Our systematic review and meta-analysis revealed that HF may result in a subsequent increase in incidence of cancer as well as in cancer-related mortality. The most prevalent cancer subtypes in HF patients were lung, female reproductive system and haematologic cancers. Further research is needed to better understand this association and to grant the best cardiological and oncological care.