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Annals of Hematology

, Volume 98, Issue 1, pp 101–109 | Cite as

Cardiovascular disease in chronic myelomonocytic leukemia: do monocytosis and chronic inflammation predispose to accelerated atherosclerosis?

  • Mette Vestergaard Elbæk
  • Anders Lindholm Sørensen
  • Hans Carl Hasselbalch
Original Article

Abstract

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.

Keywords

Chronic myelomonocytic leukemia MPN/MDS Cardiovascular disease Atherosclerosis Chronic inflammation 

Abbreviations

AMI

Acute myocardial infarction

AML

Acute myeloid leukemia

CHIP

Clonal hematopoiesis of indeterminate potential

CI

Confidence interval

CLL

Chronic lymphocytic leukemia

CMML

Chronic myelomonocytic leukemia

DRG

Diagnosis-related group

CVD

Cardiovascular disease

DM-II

Type II diabetes

HR

Hazard ratio

IHD

Ischemic heart disease

MDS

Myelodysplastic syndrome

MPN

Myeloproliferative neoplasm

NO

Nitric oxide

OR

Odds ratio

SNOMED

Systematized Nomenclature of Medicine – Clinical Terms

TCI

Transitory cerebral ischemia

Notes

Acknowledgements

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.

Authors’ contribution

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.

Ethical approval

For this retrospective study, formal consent is not required.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Hematology, Roskilde HospitalUniversity of CopenhagenRoskildeDenmark
  2. 2.København ØDenmark
  3. 3.Institute for Inflammation Research, Center for Rheumatology and Spine Diseases, RigshospitaletCopenhagen University HospitalCopenhagenDenmark

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