Myelodysplastic Syndromes and the Risk of Cardiovascular Disease in Older Adults: A SEER-Medicare Analysis

Abstract

Background: Despite recent data on clonal hematopoiesis, it remains unclear if patients with Myelodysplastic Syndromes (MDS) have a higher risk of cardiovascular disease (CVD) compared to the general population, as prior studies have not included a control group. Methods: Matched cohort study of MDS cases identified between 2004 and 2014 from Medicare claims linked to the SEER tumor registry, with controls from a 5% random sample of non-cancer Medicare beneficiaries. Patients with CVD prior to MDS diagnosis were excluded. Findings: A total of 9,047 MDS cases were 1:1 propensity-matched with non-cancer controls, based on age, gender, race and urban residence. The cumulative incidence of CVD was higher among MDS patients compared to controls (17% vs. 13%, p<0.001). In multivariate regression adjusted for gender, age, race, and comorbidities, MDS was associated with a higher risk of incident CVD (HR 1.2; 95% CI, 1.1-1.3), and death after incident CVD (HR, 2.1; 95% CI, 1.9-2.4) compared to controls. MDS was associated with an increased risk of myocardial infarction (HR, 1.4; 95% CI, 1.2-1.5) but there was no association with risk of ischemic stroke. In multivariate analysis of the 13,972-patient MDS cohort, higher-risk MDS (HR, 1.1; 95% CI, 1.02-1.2) and red blood cell transfusion dependence (HR, 1.3; 95% CI, 1.2-1.5) were associated with a higher risk of CVD. Interpretation: MDS is an independent risk factor for CVD, especially myocardial infarction. Optimal CVD screening and preventive strategies in MDS patients might improve survival. Funding Statement: SBM is supported by the National Institutes of Health (K23NS105948). AS is supported by the National Cancer Institute Paul Calabresi Career Development Award (5K12CA132783-10). Declaration of Interests: The authors declare no potential financial or ethical conflicts of interest. Ethics Approval Statement: The study was approved by the Albert Einstein College of Medicine/Montefiore Medical Center Institutional Review Board.