Cardiovascular disease in chronic myelomonocytic leukemia: do monocytosis and chronic inflammation predispose to accelerated atherosclerosis?
Patients with chronic myelomonocytic leukemia (CMML) have monocytosis and likely a state of chronic inflammation. Both have been associated with an increased risk of atherosclerosis. The aim of the study was to test the hypothesis that CMML patients are at increased risk of developing cardiovascular disease (CVD) due to persistent monocytosis and sustained chronic inflammation. In a retrospective cohort study, we assessed hazards for cardiovascular events after diagnosis in 112 CMML patients and 231 chronic lymphocytic leukemia (CLL) patients. Analyses were carried out on restricted cohorts (CMML = 84, CLL = 186), excluding patients with a prior history of CVD, as well as on unrestricted cohorts. In the restricted cohorts, a significant effect of cardiovascular event occurrence did not remain after adjustment (HR 2.49, 95% CI 0.94–6.60). In unrestricted cohorts, we found a more than twofold increased rate of cardiovascular events in CMML (HR 2.34, 95% CI 1.05–5.20). Our results indicate an increased risk of CVD after the diagnosis in CMML patients.
KeywordsChronic myelomonocytic leukemia MPN/MDS Cardiovascular disease Atherosclerosis Chronic inflammation
Acute myocardial infarction
Acute myeloid leukemia
Clonal hematopoiesis of indeterminate potential
Chronic lymphocytic leukemia
Chronic myelomonocytic leukemia
Type II diabetes
Ischemic heart disease
Systematized Nomenclature of Medicine – Clinical Terms
Transitory cerebral ischemia
Ole Weis Bjerrum, Department of Hematology, Rigshospitalet, Copenhagen, and Daniel El Fassi, Department of Hematology, Herlev Hospital, Herlev, made data collection possible from the respective departments.
HCH and MVE provided the conception and design of the study, acquisition and interpretation of data, and drafting and revision of the article. ALS provided the acquisition of data, statistical assistance, and revision of the article. All authors gave their final approval of the version to be submitted.
Compliance with ethical standards
The study was reported to The Danish Data Protection Agency, approved by The Danish Health and Medicines Authority, and it was conducted in accordance with the ethical principles stated in the Declaration of Helsinki.
Conflict of interest
ALS has received a grant from the Danish Cancer Society under Grant no. R54-A3264. HCS has received research funding from Novartis Oncology. MVE has no conflict of interest to declare.
The sources of funding had no involvement in the study design, collection, analysis, or interpretation of data; writing of the report; or the decision to submit the work for publication.
For this retrospective study, formal consent is not required.
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