Cardiovascular risk factors in myeloproliferative neoplasms: associations with survival and thrombotic outcomes

Blood Vessels, Thrombosis & Hemostasis Pub Date : 2025-01-15 DOI:10.1016/j.bvth.2025.100051

Joan How , Orly Leiva , Robert Redd , Anna E. Marneth , Daniel J. DeAngelo , Christina M. Dieli-Conwright , Areej El-Jawahri , Baransal Kamaz , Chulwoo Kim , R. Coleman Lindsley , Marlise Luskin , Maximilian Stahl , Mohammed Wazir , Lachelle D. Weeks , Gabriela S. Hobbs

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Abstract

Cardiovascular risk factors (CVRFs) are important modifiers of thrombosis in patients with essential thrombocythemia (ET), polycythemia vera (PV), and myelofibrosis (MF). We performed a retrospective cohort analysis evaluating CVRFs in 1005 patients with myeloproliferative neoplasms (MPNs) from the Dana-Farber Cancer Institute Hematologic Malignancies Data Repository from 2014 to 2023. We also included a non-MPN group of 1543 age- and sex-matched controls with no known diagnoses of hematologic malignancies to evaluate whether CVRFs differentially affected outcomes. CVRFs were identified through International Classification of Diseases codes for hypertension, hyperlipidemia, type 2 diabetes mellitus (DM2), current smoking, or body mass index ≥30 before MPN diagnosis. CVRFs occurred in 34% of patients with MPNs. Patients with MPN with ≥1 CVRF had increased risk of death (hazard ratio [HR], 2.52; 95% confidence interval [CI], 1.9-3.35) and arterial/venous thrombosis (HR, 3.05; 95% CI 2.39-3.92). Within MPN subtypes, patients with ET, PV, and MF who had CVRFs also demonstrated worse overall survival and thrombotic outcomes. Among CVRFs, only DM2 predicted worse thrombotic outcomes in patients with MPNs. The HR of CVRF on thrombosis was decreased in patients with MPNs compared with non-MPN controls (HR, 0.51; 95% CI, 0.36-0.86). Looking at ET, PV, and MF specifically, the presence of a CVRF also had less of an impact on thrombotic risk in ET compared with controls (HR, 0.35; P = .019); no interactions between MPN diagnosis and CVRFs were seen in patients with PV and MF. Our results underscore both the necessity of managing CVRFs in MPNs to improve patient morbidity and mortality and the need to ameliorate thrombotic risk with measures beyond addressing CVRFs.

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骨髓增殖性肿瘤的心血管危险因素：与生存和血栓结局的关系

摘要心血管危险因素（CVRFs）是原发性血小板增多症（ET）、真性红细胞增多症（PV）和骨髓纤维化（MF）患者血栓形成的重要调节因子。我们进行了一项回顾性队列分析，评估了2014年至2023年来自丹娜-法伯癌症研究所血液恶性肿瘤数据库的1005例骨髓增生性肿瘤（mpn）患者的cvrf。我们还纳入了1543名年龄和性别匹配的非mpn组，这些对照组没有已知的血液恶性肿瘤诊断，以评估CVRFs是否对预后有差异影响。cvrf通过国际疾病分类代码确定为高血压、高脂血症、2型糖尿病（DM2）、当前吸烟或MPN诊断前体重指数≥30。34%的mpn患者发生cvrf。CVRF≥1的MPN患者死亡风险增加(危险比[HR]， 2.52；95%可信区间[CI]， 1.9-3.35)和动脉/静脉血栓形成(HR, 3.05；95% ci 2.39-3.92)。在MPN亚型中，有CVRFs的ET、PV和MF患者也表现出更差的总生存率和血栓结局。在cvrf中，只有DM2预测mpn患者更差的血栓结局。与非mpn对照组相比，mpn患者CVRF对血栓形成的HR降低(HR, 0.51；95% ci, 0.36-0.86)。特别观察ET、PV和MF，与对照组相比，CVRF的存在对ET血栓形成风险的影响也较小(HR, 0.35；P = .019)；PV和MF患者的MPN诊断与cvrf无相互作用。我们的研究结果强调了在mpn中管理cvrf以改善患者发病率和死亡率的必要性，以及通过解决cvrf之外的措施改善血栓形成风险的必要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Blood Vessels, Thrombosis & Hemostasis

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