Population-Based Study Finds Increased Risk of Stroke, Heart Attack in Patients With MM

A real-world study of patients with multiple myeloma (MM) in the United States found that heart attack and stroke risks are significantly higher in this patient population compared with the general population. The findings were presented as an abstract at the 64th American Society of Hematology Annual Meeting and Exposition held in New Orleans, Louisiana.

Patients with MM are at an increased risk of arterial and venous thrombosis, but there is a lack of real-world studies exploring the association between MM and arterial thrombosis in the United States. The retrospective study aimed to characterize the risk of stroke and heart attack in this patient population using a database of patient records spanning 26 health care systems in 50 states (IBM Explorys).

Sex, age (older than 65 years), hypertension, hyperlipidemia, diabetes, smoking status, and atrial fibrillation were also evaluated as risk factors for heart attack and stroke in the study. A multivariable logistic regression factoring in these covariates was conducted to determine the associations between MM and heart attack, as well as stroke.

A total of 70,434,190 patients were included in the cohort, 67,920 of whom were diagnosed with MM between 1999 and 2022. Most patients (77%) were older than 65 years and 52% were men. Regarding comorbidities, 19% of patients in the cohort were obese, 67% had hypertension, 53% had hyperlipidemia, 31% had diabetes, and 21% had atrial fibrillation.

In the MM cohort, 600 patients experienced a stroke and 5370 experienced a heart attack (0.88% and 7.9% of the MM group, respectively). The risk of stroke was substantially higher in the MM group compared with patients who did not have MM, even after adjusting for confounding risk factors (odds ratio [OR], 1.51; 95% CI, 1.43-1.59). Patients with MM were also more likely to experience a heart attack compared with the general population (OR, 1.36; 95% CI, 1.32-1.39).

The study is the largest real-world assessment of arterial thrombotic events among patients with MM in the United States. Overall, individuals with MM were 51% more likely to have a stroke and 36% more likely to have a heart attack compared with patients who did not have MM. However, further research is needed to identify at-risk individuals and to risk stratify these patients. “Given the enormity of the risk, physicians should consider optimizing modifiable risk factors in all patients with multiple myeloma,” the authors concluded.

Reference
Al Armashi AR, Elantably D, Wang J, Al Zubaidi A, Alkrekshi A. The risk of stroke and myocardial infarction in multiple myeloma: a population-based study in the United States. Presented at: 64th American Society of Hematology Annual Meeting and Exposition; New Orleans, LA; December 10-13, 2022; Abstract 3215. Accessed December 17, 2022. https://ash.confex.com/ash/2022/webprogram/Paper166847.html