In two studies recently reported in JACC: CardioOncology, Upshaw and colleagues1 examined the impact of preexisting heart failure on mortality in older patients in the United States with newly diagnosed Hodgkin lymphoma, and Gon and colleagues2 analyzed the incidence and impact of arterial thromboembolism in Japanese patients with cancer.
Preexisting Heart Failure in Older Patients With Hodgkin Lymphoma
In a retrospective study, Jenica N. Upshaw, MD, of the Division of Cardiology, Tufts Medical Center, Boston, and colleagues, found that preexisting heart failure was associated with an increased risk of lymphoma and cardiovascular mortality among patients aged ≥ 65 with newly diagnosed Hodgkin lymphoma.1 The study used linked Surveillance, Epidemiology, and End Results and Medicare data from 1999 to 2016 to identify patients aged ≥ 65 with newly diagnosed Hodgkin lymphoma.
Jenica N. Upshaw, MD
Among 3,348 patients (mean age = 76 ± 7 years) included in the analysis, 437 (13.1%) had preexisting heart failure. Comorbidities apart from preexisting heart failure included coronary artery disease (29.0%), atrial fibrillation (13.4%), peripheral vascular disease (15.8%), hypertension (67.2%), diabetes (31.2%), and hyperlipidemia (59.1%).
In the first year after Hodgkin lymphoma diagnosis, 56.9% of patients received anthracycline-based chemotherapy (35% of those with preexisting heart failure and 60% of those without heart failure), 10.9% received nonanthracycline chemotherapy, and 32.2% received no chemotherapy. Radiation therapy was used in 23.4%, and less than 1% underwent hematopoietic cell transplantation. Among patients receiving anthracyclines in the first year, cardioprotective treatment with dexrazoxane or liposomal doxorubicin was used in approximately 7% of those with preexisting heart failure and 4.1% of those without heart failure.
In an analysis adjusted for other comorbidities, patients with preexisting heart failure had a greater risk for lymphoma mortality (hazard ratio [HR] = 1.25, 95% confidence interval [CI] = 1.06–1.46) and cardiovascular mortality (HR = 2.57, 95% CI = 1.96–3.36) vs patients without preexisting heart failure. For patients with vs without preexisting heart failure, the cumulative incidence of lymphoma mortality was 37.4% vs 26.3% at 1 year and 46.7% vs 35.9% at 5 years. The cumulative incidence of cardiovascular mortality was 7.9% vs 2.9% at 1 year and 14.5% vs 6.8% at 5 years.
Preexisting heart failure was associated with a reduced likelihood of treatment with anthracycline-based chemotherapy (odds ratio [OR] = 0.42, 95% CI = 0.29–0.60). Among patients with preexisting heart failure who received chemotherapy, those who received anthracycline-based chemotherapy had a reduced risk for lymphoma mortality vs those who received nonanthracycline treatment (HR = 0.44, 95% CI = 0.28–0.71). No significant benefit in cardiovascular mortality (HR = 0.62, 95% CI = 0.33–1.15) or time to first heart failure hospitalization (HR = 1.07, 95% CI = 0.76–1.51) was observed with the use of anthracycline-based vs nonanthracycline treatment.
The investigators concluded: “Preexisting heart failure in older patients with newly diagnosed Hodgkin lymphoma is common and associated with higher 1-year mortality. Strategies are needed to improve lymphoma and cardiovascular outcomes in this high-risk population.”
Arterial Thromboembolism in Japanese Patients With Cancer: Risk and Mortality
In a Japanese retrospective study, Yasufumi Gon, MD, PhD, of the Department of Neurology, Osaka University Graduate School of Medicine, and colleagues identified the incidence and outcomes of arterial thromboembolism in patients with cancer.2
Yasufumi Gon, MD, PhD
The study focused on data on 97,448 patients with cancer (median age = 70 years) from the Osaka Cancer Registry linked with administrative data from 2010 to 2015. Patients were monitored for 5 years after cancer diagnosis. The incidence of arterial thromboembolism was ascertained. Restricted mean survival time was used to evaluate whether antithrombotic therapy after arterial thromboembolism was associated with improved survival.
A total of 2,159 patients developed arterial thromboembolism. The cumulative incidence of the disease peaked at 1 year after cancer diagnosis at 1.29%; cumulative incidence rates were 1.8%, 2.1%, 2.2%, and 2.3% at 2, 3, 4, and 5 years. In the first year after cancer diagnosis, the highest cumulative incidence of arterial thromboembolism was found in patients with pancreatic cancer (2.1%), brain tumors (2.0%), bladder cancer (2.0%), lung cancer (1.9%), and hematologic malignancies (1.8%). At 5 years, the highest cumulative incidence was found in patients with bladder cancer (3.4%), hematologic malignancies (3.1%), lung cancer (3.1%), pancreatic cancer (3.1%), and brain tumors (2.8%).
In an adjusted analysis, an increased risk of arterial thromboembolism was associated with the following factors: male sex (HR = 1.25, 95% CI = 1.13–1.38); advanced age (HRs = 1.67, 95% CI = 1.47–1.90, for age ≥ 65 to > 75 and 1.89, 95% CI = 1.66–2.16 for ≥ 75 vs < 65); history of atrial fibrillation (HR = 3.34, 95% CI = 2.88–3.88); previous arterial thromboembolism (HR = 2.41, 95% CI = 1.97–2.94); dyslipidemia (HR = 2.35, 95% CI = 2.09–2.63); history of heart failure (HR = 2.09, 95% CI = 1.77–2.46); renal disease (HR = 2.06, 95% CI = 1.73–2.46); previous antiplatelet therapy (HR = 1.41, 95% CI = 1.22–1.64); and cancer stage of regional (HR = 1.17, 95% CI = 1.04–1.31) and distant (HR = 1.30, 95% CI = 1.14–1.49) vs local. Higher body mass index was associated with a reduced risk, with hazard ratios of 0.71 (95% CI = 0.63–0.79) for ≥ 18.5 to < 25 kg/m2 and 0.60 (95% CI = 0.52–0.69) for ≥ 25 kg/m2 vs < 18.5 kg/m2.
Patients with arterial thromboembolism had a significantly increased risk of mortality vs those without the disease (HR = 2.02, 95% CI = 1.86–2.20, P < .001). For patients who received antithrombotic therapy after arterial thromboembolism vs those who did not, 90-day and 1-year restricted mean survival time differences were + 13.3 days (95% CI = 10.4–16.2 days; P < .001) and + 57.8 days (95% CI = 43.1–72.5 days, P < .001), respectively.
The investigators concluded: “The risk for arterial thromboembolism varies according to sex, age, and cancer progression and type. Antithrombotic therapy after arterial thromboembolism is associated with improved survival among patients with cancer.”
DISCLOSURE: The study by Upshaw et al was supported by the National Institutes of Health. The study by Gon et al was supported by the Japan Society for the Promotion of Science. For full disclosures of the study authors, visit www.jacc.org//journal/cardio-oncology.
REFERENCES
1. Upshaw JN, et al: Impact of preexisting heart failure on treatment and outcomes in older patients with Hodgkin lymphoma. JACC CardioOncol 6:200-213, 2024.
2. Gon Y, et al: Arterial thromboembolism in Japanese patients with cancer: Incidence, predictors, and survival impact. JACC CardioOncol 6:283-297, 2024.
