High Risk of Cardiovascular Death in Patients with MPN

Patients with myeloproliferative neoplasms (MPN) have a high risk of death from cardiovascular causes, according to a recent study.

Orly Leiva, MD, of the New York University Grossman School of Medicine, and colleagues conducted the research and presented its findings at the 2022 American Society of Hematology Annual Meeting and Exposition.

Dr. Leiva and colleagues conducted the retrospective cohort study using the Surveillance, Epidemiology, and End Results (SEER) database to evaluate all-cause death and cardiovascular death in patients with MPN. All patients were aged 18 years or older, had known survival time, and histologic or laboratory confirmation of MPN between 2005 and 2018.

The study included 28,618 patients, most of whom had essential thrombocytopenia (n=12,941) or polycythemia vera (n=11,466). The remaining patients had primary myelofibrosis (n=4,211). The median patient age at diagnosis was 67 years, 51.3% of patients were female, and 73.8% of patients were non-Hispanic White.

Just under one-third (32.8%) of patients died, with 25.3% of those deaths being cardiovascular deaths. In the group of patients with polycythemia vera, 30% of deaths were cardiovascular deaths, while 29.5% of deaths in the group of patients with essential thrombocytopenia were cardiovascular deaths. In patients with primary myelofibrosis, cardiovascular deaths represented 12.6% of deaths.

The incidence of two-year cardiovascular death was similar for all patients who were diagnosed between 2014 and 2016 and those who were diagnosed between 2005 and 2007. However, after Cox proportional hazards regression and competing-risk regression, the risk of all-cause death and cardiovascular death decreased in patients who were diagnosed between 2017 and 2018 compared with those who were diagnosed between 2005 and 2007.

Primary myelofibrosis, non-Hispanic Black race, rural residence, living in a county with a median income of less than $70,000, age at diagnosis, and additional non-MPN malignancies were associated with increased risk of all-cause death, according to results from a multivariable Cox proportional hazards regression. After competing-risk regression, non-Hispanic Black race and age were associated with increased risk of cardiovascular death.

“Patients with MPN are at high risk of [cardiovascular] death, with one in four deaths attributable to [cardiovascular] cause. While [all-cause death] and [cardiovascular] death risk has decreased over time, two-year [all-cause death] and [cardiovascular death] rates have remained static, suggesting opportunities for improvement in short-term [cardiovascular] risk. Additionally, our study highlights socioeconomic and health disparities with patients living in rural, low-income areas and being of non-Hispanic Black race being at higher risk of [all-cause death] and [cardiovascular] death.”

Reference

Leiva O, How CJ, Brunner AM, et al. Trends in all-cause and cardiovascular mortality among patients with myeloproliferative neoplasms: a Surveillance, Epidemiology, and End Results Database analysis. Abstract #3030. Presented at the 64th ASH Annual Meeting and Exposition; December 10-13, 2022; New Orleans, Louisiana.