Lymphoma May Raise Risk of Heart Failure

Common chemotherapy drugs may play a role

Health Writer
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If you’re diagnosed with a serious condition like lymphoma, then it’s enough just to deal with the disease, let alone worry about associated risks. But forewarned is forearmed. When you have lymphoma, there are certain variables that may increase your risk of also developing heart failure.

Lymphomas are cancers that originate in the lymphatic system. The lymphatic system makes up part of your body’s germ-fighting network. The lymphatic system includes the lymph nodes, spleen, thymus gland, and bone marrow. Lymphoma can affect any of those areas, and it can also involve organs throughout the body, including the heart.

The evidence

Research presented at the American College of Cardiology 67th Annual Scientific Session in 2018 analyzed data from the Rochester Epidemiology Project. Heart failure was retrospectively identified in 900 lymphoma and breast cancer patients and in 1,550 non-cancer patients who were followed from 1985 through 2010. All subjects were matched for age, gender, and for heart disease risk factors including diabetes and hypertension.

To be clear, most people diagnosed with lymphoma (both Hodgkin’s and non-Hodgkin’s lymphomas) do not develop heart failure. Earlier studies have shown an overall increased risk for various heart diseases. This study found that individuals with lymphoma (and breast cancer) were three times more likely to develop heart failure compared to individuals who did not have these types of cancer.

The researchers specifically focused on cancer patients who received an anthracycline chemotherapy drug, such as doxorubicin. They are known to cause heart damage in some people by changing the heart muscle’s DNA. The researchers found that:

  • Having lymphoma or breast cancer was linked to a three-times higher risk of developing heart failure within five years of initial diagnosis. By year 20, patients were twice as likely to be diagnosed with heart failure.
  • Seven out of every one hundred cancer patients in the analysis developed heart failure. Median follow up was eight and a half years.
  • Among patients with cancer who also had either diabetes or received high doses of an anthracycline chemotherapy agent, there was an even higher risk of heart failure.

The researchers could not explain the diabetes–lymphoma connection to significant risk of heart failure. Prior research shows that in the general population, diabetes is linked to a higher risk of heart disease and specifically to “silent” heart attacks. The class of chemotherapy drugs, anthracyclines, is noted to have increased cardiotoxicity the more doses one receives. In this study, the particular type of heart disease that was identified, heart failure, was notable. Other cancer treatments like chest radiation, immunotherapy, and some targeted therapies have also been linked to increased heart failure risk.

The researchers also found that the increased risk of heart failure could start as early as a year after lymphoma diagnosis, and, the longer these individuals were followed, the higher the risk of heart failure (twice the risk of heart failure at 20 year follow up).

What to do about it

As a result of the findings, the researchers recommend that lymphoma and breast cancer patients have yearly assessments for signs and symptoms that might indicate early heart failure. Those indicators include:

  • Increasing shortness of breath, especially when lying down
  • Needing two or three pillows when lying down
  • Fatigue
  • Feeling weak
  • Increased swelling in legs, abdomen
  • Irregular heart beat
  • Rapid weight gain
  • Pressure or heaviness in the chest especially when lying flat

If using an anthracycline is part of your treatment plan, it’s important to discuss the optimal dose and how long you will need to use it. Working with your doctor to make healthy lifestyle choices might also help to lower the heart disease risk.

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