medwireNews: Anthracycline exposure in young adults (YAs) who previously received cancer treatment is associated with a significantly elevated risk for heart failure, suggests research.
Among cancer survivors aged 18–39 years at diagnosis, the heart failure risk was more than doubled for those with versus without anthracycline exposure, say Elizabeth Hibler, from Northwestern University in Chicago, Illinois, USA, and colleagues.
“This association remained significant even when accounting for the competing risk for death,” they add in a research letter published in JACC: CardioOncology.
The investigators explain that although “cardiovascular disease (CVD) risk factors are prevalent, and CVD is a leading cause of death among [YA] cancer survivors,” there are limited data on the risk for heart failure in this population.
Drawing on the Northwestern Medicine Enterprise Data Warehouse (NMEDW), the team identified 12,879 YA cancer survivors diagnosed between January 2000 and January 2019, of whom 35% were men and 68% were White.
The average age of cancer diagnosis was 31.5 years and the most common tumor type in the cohort was breast cancer, in 17.2%, followed by lymphoma, thyroid cancer, and melanoma, in a respective 14.8%, 12.6%, and 11.0%. A total of 738 participants had received anthracycline-based treatment.
Over a median follow-up of 3.4 years, there were 180 incident heart failure events, diagnosed at an average age of 31.6 years.
Hibler and team found that the 5-year incidence of heart failure was significantly higher among participants who had received anthracycline than those who had not, at rates of 4.0% versus 1.3%. This equated to a 2.6-fold increased risk with anthracycline exposure after accounting for age, sex, race/ethnicity, history of hypertension or CVD, and secondary cancer diagnosis.
The increased risk for incident heart failure also remained significant after adjusting for the competing risk for death, at a hazard ratio of 2.4.
Of note, the 5-year cumulative rate of heart failure was highest among people with a diagnosis of leukemia, but the researchers point out that heart failure incidence was also significantly higher among people with kidney, bone, and breast cancer and lymphoma – tumors commonly treated with anthracycline-based therapy – than other cancer types.
The study authors acknowledge the limitations of their study, including “the lack of diversity in the NMEDW population as well as missing or incomplete data for chemotherapy dose, radiation treatment, and traditional CVD risk factors.”
And they conclude: “Longer term longitudinal studies are needed among diverse YA cancer survivors with adjudicated outcomes to better understand the combined impact of cancer treatment and traditional CVD risk factors on YA health and longevity.”
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J Am Coll Cardiol CardioOnc 2023; doi:10.1016/j.jaccao.2023.03.009