Increased Heart Failure Risk with Gastric Cancer Progression: A Nationwide Population-Based Cohort Study

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Background/Aims: Advances in gastric cancer treatment have improved survival rates, which has led to a growing interest in the risk of non-cancer-related conditions, particularly cardiovascular diseases. This study aimed to investigate the risk of heart failure in patients with gastric cancer according to their initial cancer stage. Methods: We conducted a nationwide, population-based, retrospective cohort study using the Cancer Public Library Database of Korea. Patients diagnosed with gastric cancer between 2012 and 2019 were enrolled and followed until the end of 2020. Heart failure development was defined as a new diagnosis of heart failure that required hospitalization. Based on the Surveillance, Epidemiology, and End Results Program staging for gastric cancer, patients were classified into three groups: localized, regional, and distant stages. Results: Of the 202,347 patients in the study, 16,004 (7.9%) developed heart failure during a median follow-up period of 3.6 years. The cumulative incidence of heart failure significantly increased with worsening gastric cancer stage (log-rank, p<0.001). After adjusting for age, sex, diabetes status, hypertension status, dyslipidemia status, income, residential area, and initial treatment modality, with the localized stage as the reference group, the hazard ratio for heart failure was 1.52 (95% confidence interval [CI], 1.46 to 1.58) for patients in the regional stage group and 2.87 (95% CI, 2.69 to 3.07) for those in the distant stage group. Conclusions: In patients with gastric cancer, the risk of heart failure requiring hospitalization increased with worsening cancer stage. Even in young patients and those without metabolic risk factors, close monitoring for heart failure development following cancer treatment is essential.

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