An Association Exists Between Broken Heart Syndrome and Cancer

By Rob Dillard - Last Updated: July 26, 2019

There exists a link between cancer and takotsubo syndrome (TTS) also known as broken heart syndrome, according to a study published in the Journal of the American Heart Association.

In this study, researchers recruited 1,604 patients with TTS from the International Takotsubo (InterTAK) Registry, a multicenter collaboration comprised of 26 cardiovascular centers from nine different countries. All TSS diagnoses were based on modified Mayo Clinic Diagnostic Criteria. The cohorts were divided into groups of patients with and without cancer and assessed based on both short-and long-term mortality. Moreover, they conducted a subanalysis which evaluated long-term mortality between a subset of TSS patients with a group of acute coronary syndrome (ACS) patients with or without cancer. Any patient with evidence of myocarditis was excluded from the study. The researchers measured long-term mortality using multivariable Cox-regression.

A Troubling Connection

According to the findings, cancer was observed in 267 (16.6%) of the total cohort, with breast cancer found as the most frequent type of malignancy (n=70), followed by gastrointestinal forms of cancer (n=43), respiratory tract cancer (n=35), cancer of the internal sex organs (n=39), skin cancer (n=35), lymphatic cancer (n=19), endocrine cancer (n=18), urinary tract cancer (n=14), blood cancers (n=) and cancers of the central nervous system (n=6). Furthermore, the results showed that following an analysis of subgroup data, the overall prevalence of cancer was 18% in the TTS group and 11% in the ACS cohort. Patients with cancer were older on average and more likely to trigger TTS via physical factors than patients without cancer, but less likely to have emotional triggers than those without cancer. Moreover, while short-term mortality rates were found to be comparable between TTS and ACS patients with cancer, long-term mortality rates were higher in cancer patients.

Broken heart syndrome and cancer are connected, scientists sayhttps://t.co/R2NOHYOmUK

— Dr. S. Steven Whitaker (@DrSWhitaker) July 18, 2019

“The findings of the present study have unraveled a high prevalence of malignancy in TTS patients,” the study authors wrote.

In their conclusion, they further noted that their analyses “illustrate the clinical course and unique characteristics in TTS patients with or without malignancy as compared to a cohort of ACS patients. Our findings suggest that specific malignancy‐associated factors impact the development and outcome of TTS,” adding that “to fully understand the pathophysiology of TTS and the role of malignancy in triggering or affecting outcomes, this subset of patients deserves further investigation. These factors may include analysis of specific malignancy types and metabolic and neurohumoral changes associated with it and/or the effects of distinct therapeutic molecules administered in such patients. Therefore, developing specific quantifiable metrics relevant to this unique patient population to improve outcomes is warranted.”