Myelodysplastic Syndromes and Incident Cardiovascular Disease: A Nationwide, Real-world Cohort Study

The association between myelodysplastic syndromes (MDS) and cardiovascular disease (CVD) has been suggested in prior studies, but evidence in the general population remains limited. In the present study, we evaluate the association between MDS and incident CVD in a large nationwide Japanese cohort.

We analyzed 1,137,351 individuals without prior CVD from the DeSC database in Japan between April 2014 and August 2023. MDS was identified using International Classification of Diseases-10th revision codes before the baseline health check-up. Using multivariable Cox regression, we assessed the association of MDS with ischemic heart disease (IHD), stroke, heart failure (HF), atrial fibrillation (AF), and their composite.

Among 1,137,351 individuals (median age 63 [49-68] years, 43.8% men), 550 (0.05%) had MDS. During a mean follow-up of 3.5 ± 2.3 years, 121,265 individuals experienced CVD events. MDS was significantly associated with the composite CVD outcome (hazard ratio [HR] 1.86, 95% confidence interval [CI] 1.57-2.20), as well as with each individual outcome: IHD (HR 1.62, 95% CI 1.18-2.23), stroke (HR 1.82, 95% CI 1.32-2.50), HF (HR 1.81, 95% CI 1.47-2.23), and AF (HR 2.26, 95% CI 1.52-3.38). This finding remained unchanged across age, sex, and anemia status.

MDS was independently associated with incident CVD, including IHD, stroke, HF, and AF. MDS should be recognized as an independent cardiovascular risk factor in both clinical practice and public health strategies.