Heart Failure After Myocardial Infarction Is Associated With Increased Risk of Cancer.
Heart Failure After Myocardial Infarction Is Associated With Increased Risk of Cancer.
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DOI：
10.1016/j.jacc.2016.04.053
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发表时间：
2016-07-19
影响因子：
24
通讯作者：
Roger VL
中科院分区：
文献类型：
--
作者：
Hasin T;Gerber Y;Weston SA;Jiang R;Killian JM;Manemann SM;Cerhan JR;Roger VL
心力衰竭(HF)与过度的发病率和死亡率有关，非心脏原因日益被认识到。我们以前描述过，与社区对照相比，心力衰竭患者患癌症的风险增加。在目前的研究中，我们研究了在首次心肌梗死(MI)幸存者的同种人群中，心衰是否与继发癌症风险增加有关。从2002年到2010年，在明尼苏达州奥姆斯特德县发生心肌梗塞的居民中进行了一项前瞻性队列研究。有癌症或心力衰竭诊断的患者被排除在外。共有1,081名受试者(平均年龄：±15岁，其中60%为男性)被跟踪5,327人年(平均：4.9±3.0岁)。共有228名患者发生心力衰竭，98名患者发生癌症(不包括非黑色素瘤皮肤癌)。癌症诊断的发病率密度(每千人年)：心力衰竭患者为33.7%，非心力衰竭患者为15.6%(p=0.002)。与心力衰竭相关的癌症的危险比(HR)为2.16(95%可信区间：1.39至3.35)；调整了年龄、性别和Charlson共病指数；HR：1.71(95%可信区间：1.07至2.73)。与癌症相关的死亡率比，无心衰患者为4.90(3.10~7.74)，心力衰竭患者为3.91(1.88~8.12)(交互作用P=0.76)。心肌梗死后发生心力衰竭的患者患癌症的风险增加。这一发现扩展了我们之前的报告，即与对照组相比，心力衰竭后癌症风险增加，并呼吁更好地了解共同的风险因素和潜在机制。
Heart failure (HF) is associated with excess morbidity and mortality for which noncardiac causes are increasingly recognized. We previously described an increased risk of cancer among HF patients compared with community controls. In the present study, we examined whether HF was associated with an increased risk of subsequent cancer among a homogenous population of first myocardial infarction (MI) survivors. A prospective cohort study was conducted among Olmsted County, Minnesota residents with incident MI from 2002 to 2010. Patients with prior cancer or HF diagnoses were excluded. A total of 1,081 participants (mean age: 64 ± 15 years; 60% male) were followed for 5,327 person-years (mean: 4.9 ± 3.0 years). A total of 228 patients developed HF and 98 patients developed cancer (excluding nonmelanoma skin cancer). Incidence density rates for cancer diagnosis (per 1,000 person-years) were 33.7 for patients with HF and 15.6 for patients without HF (p = 0.002). The hazard ratio (HR) for cancer associated with HF was 2.16 (95% confidence interval [CI]: 1.39 to 3.35); adjusted for age, sex, and Charlson comorbidity index; HR: 1.71 (95% CI: 1.07 to 2.73). The HRs for mortality associated with cancer were 4.90 (3.10 to 7.74) for HF-free and 3.91 (1.88 to 8.12) for HF patients (p for interaction = 0.76). Patients who develop HF after MI have an increased risk of cancer. This finding extends our previous report of an elevated cancer risk after HF compared with controls, and calls for a better understanding of shared risk factors and underlying mechanisms.