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Myelodysplastic syndrome

Myelodysplastic syndromes and the risk of cardiovascular disease in older adults: A SEER-medicare analysis

Leukemia volume 34, pages 1689–1693 (2020)Cite this article

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Clonal hematopoiesis of indeterminate potential (CHIP) is a premalignant precursor state to Myelodysplastic Syndrome (MDS). It is characterized by expansion of hematopoietic clones harboring MDS-initiating driver mutations without clinically evident cytopenia or dysplasia [1], and is associated with a 40% increased risk of cardiovascular disease (CVD), especially myocardial infarction (MI), independent of traditional risk factors [2, 3]. It is unclear if this risk persists after evolution into MDS and the relationship between CHIP mutations and CVD among MDS patients is an emerging area of research [4]. These patients experience high rates of CVD and cardiovascular mortality constitutes the most common non-disease-related cause of death in MDS [5, 6]. However, studies exploring cardiovascular risk in older adults with cancer largely exclude MDS [7] and a true estimate of the magnitude of MDS as a risk factor for CVD in the elderly remains unknown.

We performed a matched cohort study of MDS patients and non-cancer controls in a heterogenous, nationally representative sample using the Surveillance, Epidemiology, and End Results (SEER) cancer registry linked to Medicare administrative claims. The SEER-Medicare database represents 28% of the United States population from 20 disparate geographic regions and includes sociodemographic factors, clinical procedures, treatments and diagnoses from inpatient and outpatient settings in adults over 65 years, constituting a valuable resource for cancer research in the elderly [8]. The study was approved by the Albert Einstein College of Medicine Institutional Review Board. The MDS cohort included Medicare beneficiaries diagnosed with MDS between 2004 and 2014. Exclusion criteria included lack of continuous coverage, enrollment in plans not captured by administrative claims, diagnosis obtained solely from death certificates or autopsy, and documented ischemic stroke (CVA) or MI preceding MDS diagnosis. The control cohort was obtained from a 5% sample of randomly selected non-cancer Medicare beneficiaries residing in SEER regions during the study period.

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Fig. 1: Myelodysplastic Syndrome (MDS) and risk of Cardiovascular Disease (CVD).

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Acknowledgements

AS is supported by the National Cancer Institute Paul Calabresi Career Development Award (5K12CA132783–10) & The Leukemia Lymphoma Society. SBM is supported by the National Institutes of Health (K23NS105948) & the Leon Levy Foundation. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The corresponding author had full access to all the data in this study and independently made the decision to submit for publication. No medical writers or editors were involved in the creation of this manuscript. The authors wish to acknowledge the help of the SEER-Medicare staff.

Financial Disclosure

AS has received consultancy fees from Guidepoint consultation.

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Author notes

  1. These author contributed equally: Diego Adrianzen Herrera, Kith Pradhan

Authors and Affiliations

  1. Division of Hematology & Oncology, Larner College of Medicine at The University of Vermont, Burlington, VT, USA

    Diego Adrianzen Herrera

  2. Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA

    Kith Pradhan

  3. Department of Oncology, Albert Einstein College of Medicine, Bronx, NY, USA

    Rose Snyder, Ioannis Mantzaris, Ira Braunschweig, Anjali Budhathoki, Amit K. Verma & Aditi Shastri

  4. Department of Internal Medicine, McGovern Medical School of The University of Texas Health Science Center at Houston, Houston, TX, USA

    Siddharth Karanth

  5. Division of Hematology, Oncology & Transplantation, University of Minnesota, Minneapolis, MN, USA

    Murali Janakiram

  6. Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, Bronx, NY, USA

    Urvi A. Shah

  7. Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA

    Santosh B. Murthy

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  1. Diego Adrianzen Herrera
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Corresponding author

Correspondence to Aditi Shastri.

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AS has received consultancy fees from Guidepoint consultation. The remaining authors declare that they have no conflict of interest.

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Adrianzen Herrera, D., Pradhan, K., Snyder, R. et al. Myelodysplastic syndromes and the risk of cardiovascular disease in older adults: A SEER-medicare analysis. Leukemia 34, 1689–1693 (2020). https://doi.org/10.1038/s41375-019-0673-8

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