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Cardiovascular Disease Risk in Adults With Hematological Malignancies: A Population-Based Cohort Study Using Linked
Jesse Geels1, Anna van Rhenen2, Clara Gomes3
1Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Department of Hematology, Cancer Center, University Medical Center Utrecht, Utrecht, the Netherlands.
Background:
Survival rates for hematological malignancies have substantially improved over recent decades, prompting attention to treatment-related side effects and long-term health complications, including cardiovascular disease (CVD). These complications may limit cancer treatment tolerability and contribute to increased morbidity and mortality.
Objectives:
We evaluated the short- and long-term incidence of CVD across hematological malignancies.
Methods:
Adult patients (aged ≥18 years) registered in the Netherlands Cancer Registry from 1995 to 2023 diagnosed with 1 of the 12 most common hematological malignancies were matched with general population control subjects. Data were linked to national hospitalization and cause of death registries to ascertain 11 cardiovascular outcomes. Poisson regression and Fine and Gray competing risks models were used to evaluate absolute and relative CVD risk.
Results:
Among 174,984 patients with hematological malignancies matched with 855,085 control subjects, heart failure incidence was elevated across all malignancy subtypes, with highest excess rates per 1,000 person-years in myelodysplastic syndrome (37.75; 95% CI: 35.60-39.90) and multiple myeloma (24.68; 95% CI: 23.46-25.90). Venous thromboembolism risk peaked within the first year after diagnosis and remained elevated up to 5 years across all malignancies. First-year HRs for deep venous thrombosis ranged from 3.52 (95% CI: 2.58-4.80) in chronic lymphocytic leukemia to 34.04 (95% CI: 19.83-58.44) in Hodgkin lymphoma.
Conclusions:
Patients and survivors of hematological malignancies face substantially elevated short- and long-term risk of CVD compared with the general population, varying markedly by malignancy subtype. Identifying patient-, disease-, and treatment-specific drivers of this risk is essential to develop targeted prevention and management strategies to improve outcomes.
