Cardiovascular risk factors in myeloproliferative neoplasms: associations with survival and thrombotic outcomes

Cardiovascular risk factors (CVRFs) are important modifiers of thrombosis in patients with essential thrombocythemia (ET), polycythemia vera (PV), and myelofibrosis (MF). We performed a retrospective cohort analysis evaluating CVRFs in 1005 patients with myeloproliferative neoplasms (MPNs) from the Dana-Farber Cancer Institute Hematologic Malignancies Data Repository from 2014 to 2023. We also included a non-MPN group of 1543 age- and sex-matched controls with no known diagnoses of hematologic malignancies to evaluate whether CVRFs differentially affected outcomes. CVRFs were identified through International Classification of Diseases codes for hypertension, hyperlipidemia, type 2 diabetes mellitus (DM2), current smoking, or body mass index ≥30 before MPN diagnosis. CVRFs occurred in 34% of patients with MPNs. Patients with MPN with ≥1 CVRF had increased risk of death (hazard ratio [HR], 2.52; 95% confidence interval [CI], 1.9-3.35) and arterial/venous thrombosis (HR, 3.05; 95% CI 2.39-3.92). Within MPN subtypes, patients with ET, PV, and MF who had CVRFs also demonstrated worse overall survival and thrombotic outcomes. Among CVRFs, only DM2 predicted worse thrombotic outcomes in patients with MPNs. The HR of CVRF on thrombosis was decreased in patients with MPNs compared with non-MPN controls (HR, 0.51; 95% CI, 0.36-0.86). Looking at ET, PV, and MF specifically, the presence of a CVRF also had less of an impact on thrombotic risk in ET compared with controls (HR, 0.35; P = .019); no interactions between MPN diagnosis and CVRFs were seen in patients with PV and MF. Our results underscore both the necessity of managing CVRFs in MPNs to improve patient morbidity and mortality and the need to ameliorate thrombotic risk with measures beyond addressing CVRFs.