Increased risk of cancer death in patients with chronic heart failurewith a special reference to inflammation-A report from the CHART-2 Study

Background: Although several factors, including heart failure (HF) and inflammation, are known to increase the incidence of cancer, it remains unknown whether HF may increase cancer mortality, especially with a reference to inflammation. Methods and results: We examined 8843 consecutive cardiovascular patients without a prior history of cancer in our CHART-2 Study (mean 68 yrs., female 30.9%). As compared with patients without HF (Stage A/B, N = 4622), those with HF (Stage C/D, N = 4221) were characterized by higher prevalence of diabetes, previousmyocardial infarction, atrial fibrillation, and stroke. During the median 6.5-year follow-up (52,675 person-years), 282 cancer deaths occurred. HF patients had significantly higher cancer mortality than those without HF in both the overall (3.7 vs, 2.8%, hazard ratio (HR) 1.42, 95% confidence interval (CI) 1.12-1.79, P=0.004) and the propensity score-matched cohorts (HR 1.46, 95% CI 1.10-1.93, P = 0.008), which was confirmed in the competing risk models. The multivariable Cox proportional hazard model in the matched cohort showed that HF was associated with increased cancer mortality in patients with C-reactive protein (CRP) >= 2.0mg/L (HR 1.87, 95% CI 1.18-2.96, P = 0.008) at baseline, but not in those with CRP < 2.0mg/L (HR0.89, 95% CI 0.54-1.45, P=0.64) (P for interaction = 0.03). Furthermore, temporal changes in CRP levels were associated with cancer death in the overall cohort; HF patientswith CRP >= 2.0mg/L at both baseline and 1-year had significantly increased cancer death, while those with CRP = 2.0mg/L at baseline and < 2.0mg/L at 1-year not. Conclusions: These results provide the first evidence that HF is associated with increased cancer death, especially when associated with prolonged inflammation. (C) 2019 Published by Elsevier B.V.