Baseline Cardiovascular and Heart Failure Risks in Non-Hodgkin Lymphoma Survivors

Key Points

  • Preexisting cardiovascular risk factors were associated with an increased risk of heart failure in survivors of NHL.
  • Preexisting intrinsic heart disease but not vascular disease was associated with an increased heart failure risk.

In a study in the Danish population reported in the Journal of Clinical Oncology, Salz et al found that preexisting cardiovascular conditions were associated with an increased risk of heart failure in survivors of aggressive non-Hodgkin lymphoma (NHL). The standard use of anthracycline chemotherapy in this setting is known to be associated with an increased risk of heart failure.

Study Details

The study involved 2,508 survivors of NHL diagnosed between 2000 and 2010 and 7,399 sex- and age-matched general-population controls from Danish registries. The incidence of heart failure was assessed from 9 months after diagnosis through 2012. Preexisting cardiovascular factors (hypertension, dyslipidemia, and diabetes) and preexisting cardiovascular disease were ascertained only among NHL survivors. Survivors had a median age at diagnosis of 62 years, and 56% were male.

Risk of Heart Failure

During median follow-up of 2.5 years among NHL survivors, 115 were diagnosed with heart failure, representing a 42% increase in risk vs matched population controls (hazard ratio [HR] = 1.42, 95% confidence interval = 1.07–1.88). Prior to diagnosis, 39% of survivors had at least one cardiovascular risk factor. Overall, 92% received anthracycline-containing regimens.

In multivariable analysis, intrinsic heart disease (eg, pericardial disease, valvular disease, myocardial disease, and cardiomyopathy without clinical heart failure) prior to NHL diagnosis was associated with an increased risk of heart failure (HR = 2.71, 95% CI = 1.15–6.36), but no significant association (P > .05) was observed for preexisting vascular disease (eg, myocardial infarction, coronary artery disease, stable and unstable angina, cardiac arrest, stroke, carotid artery disease, and transient ischemic attack). Significantly increased risk of heart failure among survivors was observed for one vs no cardiovascular risk factors (HR = 1.63, 95% CI = 1.07–2.47) and for two vs no risk factors (HR = 2.86, 95% CI = 1.56–5.23; joint P < .01).

The investigators concluded: “In a large, population-based cohort of NHL survivors, preexisting cardiovascular conditions were associated with increased risk of [heart failure]. Preventive approaches should take baseline cardiovascular health into account.”

The study was supported by the Leukemia & Lymphoma Society, National Institutes of Health grants, and The Danish Cancer Society.

Talya Salz, PhD, of the Memorial Sloan Kettering Cancer Center, is the corresponding author of the Journal of Clinical Oncology article. 

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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