Cohort study of the association of clonal hematopoiesis with cardiovascular disease risk after cancer therapy in patients with solid tumors

Cancer survivors have increased cardiovascular disease (CVD) risk partly due to the toxic effects of cancer therapy. Clonal hematopoiesis of indeterminate potential (CHIP) is more prevalent among individuals receiving cancer therapy. It is unknown whether CHIP amplifies therapy-related cardiovascular toxic effects in patients with cancer. A cohort study using Vanderbilt University Medical Center’s biorepository investigated the association between CHIP and CVD risk among patients with primary solid tumors who received chemotherapy, radiotherapy, or immunotherapy. Among 8004 eligible participants, 549 (6.9%) had CHIP. In the propensity score-matched cohort, participants with CHIP had a significantly higher 10-year cumulative incidence of heart failure (20.3% versus 14.5%; p=0.001) and ischemic CVD (25.3% versus 18.5%; p<0.001) compared with those without CHIP. In adjusted Fine-Gray models, CHIP was associated with increased risk of heart failure (sHR 1.26; p=0.03). The associations were more pronouced among patients receiving higher cumulative doses of chemotherapy. The authors conclude that CHIP testing may improve cardiovascular risk stratification in oncology patients.