Cardiovascular Risk in Patients with Hematological Malignancies: A Systematic Review and Meta-Analysis

Abstract

Patients with haematological malignancies (HM) are at risk of future cardiovascular (CV) events. We therefore conducted a systematic review and meta-analysis to quantify their risk of future CV events. We searched Medline and Embase databases from inception till 31 January 2023 for relevant articles using a combination of keywords and medical subject headings. Studies examining CV outcomes in patients with HM versus controls without HM were included. Outcomes of interest included acute myocardial infarction (AMI), heart failure (HF), and stroke. The outcomes were expressed as hazard ratios (HR) and their 95% confidence intervals (95% CI). This study is registered with PROSPERO at CRD42022307814. Fifteen studies involving 1,960,144 cases (178,602 patients with HM and 1,781,212 controls) were included in the quantitative analysis. Ten studies examined the risk of AMI, 5 examined HF, and 11 examined stroke. When compared with the control group, the HRs for HM for AMI, HF, and stroke were 1.65 (95% CI 1.29–2.09, p<0.001), 4.82 (95% CI 3.72–6.25, p<0.001), and 1.60 (95%CI 1.30–1.97, p<0.001) respectively. Sensitivity analysis of stroke risk based on lymphoma type showed an increased risk of stroke in patients with non-Hodgkin's lymphoma compared to controls (HR 1.31, 95% CI 1.04-1.64, p=0.03), but no significant difference for Hodgkin's lymphoma (HR 1.67, 95% CI 0.86-3.23, p=0.08). Patients with HM are at increased risk of future AMI, HF, and stroke, and these findings suggest that CV care of patients with HM should be considered as a growing priority.