Risk Factors for Incident Heart Failure Among Cancer Survivors Aged 18 to 39

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In a study reported in a research letter in JACC: CardioOncology, Hibler et al found that survivors of young adult cancers who were exposed to anthracyclines were at an increased risk of subsequent diagnosis of heart failure.

Study Details

The study involved electronic health record data from the Northwestern Medicine Enterprise Data Warehouse (covering Chicago and satellite locations) from patients aged 18 to 39 diagnosed with incident cancer between January 2000 and January 2019. Analyses were adjusted for age, sex, race/ethnicity, history of hypertension or cardiovascular disease, and secondary cancer diagnosis.

Key Findings

Among 12,879 young adult cancer survivors included in the analysis, mean age at cancer diagnosis was 31.5 ± 5.7 years. The most common young adult cancers were breast cancer (17.2%), lymphoma (14.8%), thyroid cancer (12.6%), and melanoma (11.0%). The frequency of cardiovascular comorbidities did not significantly differ according to anthracycline use.

Over a median follow-up of 3.4 years (interquartile range = 1.3–7.1 years), incident heart failure was diagnosed in 180 patients. Mean age at heart failure diagnosis was 31.6 ± 5.7 years. The 5-year incidence of heart failure was 4.0% among young adult cancer survivors with anthracycline exposure vs 1.3% among those without anthracycline exposure (hazard ratio [HR] = 2.6, 95% confidence interval [CI] = 1.6­%–4.9%, P < .01). The risk for incident heart failure remained significant after adjustment for competing risk for death (HR = 2.4, 95% CI = 1.5–3.7, P < .01).

Among survivors of cancers commonly treated with anthracyclines, the 5-year cumulative incidence of heart failure was highest among leukemia survivors. Incidence rates were also significantly higher among survivors of kidney cancer, lymphoma, bone cancer, and breast cancer vs other cancer types (P < .01).

The investigators stated: “We found that young adult survivors of common cancers, specifically those treated with anthracycline chemotherapy, are at increased risk not only for heart failure but also for early-onset [heart failure] (< 45 years of age). This association remained significant even when accounting for the competing risk for death.”

Elizabeth Hibler, PhD, MPH, of Northwestern University, Chicago, is the corresponding author of the JACC: CardioOncology article.

Disclosure: The study was supported by the National Heart, Lung, and Blood Institute. For full disclosures of the study authors, visit

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