Cardiovascular Disease Risk in Adult Patients with Hematological Malignancies: A Population-Based Cohort Study Using Linked Databases
Survival rates for hematological malignancies have substantially improved over recent decades, prompting growing attention to treatment-related side effects and long-term health complications, including cardiovascular disease (CVD). These complications may limit treatment tolerability and contribute to increased morbidity and mortality. However, the short- and long-term incidence of CVD across different hematological malignancies remains unclear.
For this population-based cohort study, all adult patients (≥18 years) registered in the Netherlands Cancer Registry from 1995 and 2023 with a diagnosis of one of the 12 most common hematological malignancies were matched to general population controls. Data was subsequently linked to national hospitalization and cause of death registries to ascertain cardiovascular outcomes. Poisson regression and Fine & Gray competing risks models were used to evaluate absolute and relative CVD risk for each hematological malignancy subtype.
Among 174,984 patients with hematological malignancies matched to 855,085 controls, heart failure incidence was elevated across all malignancy subtypes, with the highest excess rates per 1,000 person-years in myelodysplastic syndrome (37·75; 95%CI 35·60-39·90), multiple myeloma (24·68; 95%CI 23·46-25·90), and acute myeloid leukemia (20·67; 95%CI 18·72-22·62). Venous thromboembolism risk peaked within the first year after diagnosis and remained elevated up to five years across all malignancies except indolent non-Hodgkin lymphoma. First year hazard ratios (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. For pulmonary embolism, HRs varied from 2·24 (95%CI 1·70-2·95) in myelodysplastic syndrome to 23·69 (95%CI 15·39-36·47) in Hodgkin lymphoma.
Patients and survivors of hematological malignancies face substantially elevated short- and long-term risk of CVD compared to 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 and improve outcomes.