Heart failure (HF) may increase the risk of developing cancer and the risk of cancer-related mortality, according to research published in JACC: CardioOncology.

The researchers noted that the possible association between HF and cancer has received increasing attention in recent years. However, a causal relationship between HF and cancer has been difficult to determine, given the number of possible covariates and confounders inherent to epidemiological research in this area. 

For the current study, researchers aimed to evaluate the incidence of cancer and cancer-related mortality in a large cohort of patients with HF and matched control individuals.

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All subjects were at least 50 years of age or older, lived in the Puglia region of Italy, and did not have a cancer diagnosis within 3 years of baseline. The HF patients were matched to control individuals based on age, sex, drug-derived complexity index, and duration of follow-up.

Data from 208,040 individuals were included — 104,020 patients with HF and 104,020 healthy control individuals. The mean age was 76 ± 10 years, and 46.8% of patients in each group were men. 


Over a median follow-up of 5 years, there were 12,036 new cancer diagnoses in the HF group and 7045 in the control group. 

The incidence rate (IR) of any cancer was 21.36 per 1000 person-years in the HF group and 12.42 per 1000 person-years in the control group (hazard ratio [HR], 1.76; 95% CI, 1.71-1.81; P <.001).

HF patients had a significantly higher risk of most solid tumors and hematologic malignancies. For example, HF patients had a significantly higher risk of colorectal cancer (HR, 1.46; 95% CI, 1.35-1.57; P <.001), lung cancer (HR, 4.49; 95% CI, 4.06-4.98; P <.001), lymphoma (HR, 1.84; 95% CI, 1.54-2.20; P <.001), and myeloma (HR, 2.33; 95% CI, 1.94-2.80; P <.001). 

On the other hand, HF patients had a lower risk of male reproductive system cancer (HR, 0.90; 95% CI, 0.83-0.98; P <.005), and the risk of female breast cancer was similar between the groups (HR, 1.05; 95% CI, 0.95-1.15).

Cancer-related mortality was significantly more common in the HF group (HR, 4.11; 95% CI, 3.86-4.38; P <.001), and this finding was confirmed in a competing risk analysis (sub-distribution HR, 3.48; 95% CI, 3.27-3.72).

The researchers also found that patients with HF who were prescribed high-dose loop diuretics had a higher risk of cancer (HR, 1.11; 95% CI, 1.03-1.21; P =.013) and cancer-related mortality (HR, 1.35; 95% CI: 1.19-1.53; P <.001). 

“In this community-based cohort study, we found increased cancer incidence and mortality in patients with HF compared with matched control subjects,” the researchers concluded. “The excess risk applied to several common types of solid and hematologic malignancies, and appeared to be correlated with the severity of HF as estimated by exposure to loop diuretics.”


Bertero E, Robusto F, Rulli E, et al. Cancer incidence and mortality according to pre-existing heart failure in a community-based cohort. JACC: CardioOncology. Published online January 18, 2022. doi:10.1016/j.jaccao.2021.11.007