Connecting Heart Disease and Hematologic Malignancies

Blood Cancer: © Hadi - stock.adobe.com

Survival in patients with acute coronary syndrome (ACS) who also have a hematologic malignancy (HM) is markedly lower than in patients without a HM, and diagnosis with ACS and multiple myeloma (MM) was associated with the worst survival outcomes, according to a real-world analysis.¹

A total of 2104 patients with ACS and a HM were analyzed, and once adjusted for patient risk profile, HM was associated with reduced long-term survival. Patients with ACS and a HM were less likely to undergo coronary angiography (65.3% v 71.6%) and percutaneous coronary intervention (PCI; 44.3% v 52.0%). Investigators postulated that reluctance towards these procedures was due to a perceived increased risk of bleeding. However, it did not appear that the number of bleeding events was significantly increased, with bleeding events occurring in 7.9% of the ACS/HM cohort compared with 6.7% of the control cohort.

In-hospital mortality (16.8% v 14.4%), 30-day mortality (18.4% v 15.0%), and 90-day mortality (28.8% v 19.3%) were all higher in the ACS/HM cohort than the control cohort. Patients with multiple myeloma and ACS had the worst prognosis, with a survival probability of less than 0.1 at 8 years.

Interestingly, Hodgkin lymphoma was the only HM not associated with a worse prognosis. Survival probability at 8 years in patients with Hodgkin lymphoma was about 0.5, whereas patients without a HM had a survival probability of less than 0.4 at the same time.

“For the occurrence of ACS in association with hematologic malignant disease, little data are available that have adequately investigated this issue. The present retrospective study aimed to shed light on this issue and, therefore, focused on various forms of malignant hematologic disorders that occurred in patients with an ACS as a co-diagnosis,” according to the authors of the study published in Cancers. “However, our analysis is purely observational and does not allow for any conclusion about causal interactions.”

Multiple Myeloma: © David A Litman - stock.adobe.com

Looking at patient characteristics, those with ACS and a HM were an average of 6 years older than ACS patients without HM (78 years v 72 years) and typically experienced higher rates of cardiovascular risk factors including diabetes mellitus (50% v 44.1%), hypertension (93.9% v 89.5%), and psychiatric disorders (18.1% v 14.6%). Moreover, patients with ACS/HM had poorer New York Heart Association (NYHA) stages (NYHA stage IV, 32.5% v 19.9%) and more frequent incidences of chronic heart failure (70.2% v 52.6%) and atrial fibrillation (39.0% v 25.8%).

Patients with Hodgkin lymphoma, follicular and non-follicular lymphoma, aggressive lymphoma, plasmacytoma and malignant plasma cell neoplasm, lymphocytic leukemia, myeloid leukemia, and myelodysplastic and myeloproliferative diseases were included in the study.

Links Between Hematologic Malignancies and Cardiovascular Events

This study supports other work done in HMs and ACS. A 2022 study found that a new cancer diagnosis was independently associated with an increased risk of death by cardiovascular (CV) event, as well as nonfatal morbidity, and HM was the cancer type with the highest rate of CV deaths (3.7 per 1000 participant-years) and heart failure (12.0 per 1000 participant-years).²

Treatments for HMs can carry their own risks of increased ACS or CV events. Radiotherapy, which can improve survival rates in lymphoma, may cause vascular damage, pericardial disease, and valve disease. Moreover, mediastinal radiotherapy was linked with a 2- to 7-fold increased risk of ischemic heart disease, heart failure, and valvular disease in patients with Hodgkin lymphoma.³

Retrospective studies have also found that patients who develop high-grade cytokine release syndrome when receiving chimeric antigen receptor T-cell therapy are at greater risk of CV event.

REFERENCES:

1. Lange SA, Schliemann C, Engelbertz C, et al. Survival of patients with acute coronary syndrome and hematologic malignancies—a real-world analysis. Cancers (Basel). 2023;15(20):4966. Published 2023 Oct 12. doi:10.3390/cancers15204966

2. Paterson I, Wiebe N, Cheung W, et al. Incident cardiovascular disease among adults with cancer: a population-based cohort study. JACC CardioOncol. 2022;4(1):85-94. Published 2022 Mar 15. doi:10.1016/j.jaccao.2022.01.100

3. Omland T, Lagethon Heck S, Gulati G. The role of cardioprotection in cancer therapy cardiotoxicity: JACC: CardioOncology state-of-the-art review.JACC CardioOncol. 2022;4(1):19-37. Published 2022 Mar 15. doi:10.1016/j.jaccao.2022.01.101