Diabetes and Obesity as Risk Amplifiers for Cancer in Heart Failure Patients: a retrospective study, using an electronic health record network

Background: Evidence suggests a bidirectional relationship between heart failure (HF) and cancer. Type 2 diabetes mellitus (T2DM) and obesity are independently associated with increased cancer risk, yet their combined impact in HF patients remains incompletely characterized. The objective of the present study is to evaluate the incidence and prevalence of neoplasms in patients with HF, and to determine whether the coexistence of T2DM and obesity further increases cancer risk in this population. Methods: Using the TriNetX Global Collaborative Network, we identified patients with HF; separate cohorts were constructed based on the presence or absence of T2DM and obesity. Outcomes were assessed over a ten-year follow-up using Kaplan–Meier survival analysis, Cox proportional hazards regression, and competing risk analysis accounting for mortality as a competing event. Results: The HF cohort showed a neoplasm prevalence of 30.6% and an incidence of 20.7% over 5 years. Cox regression confirmed age, obesity and nicotine dependence as independent risk factors. Competing risk analysis revealed a 10-year cumulative neoplasm incidence of 39.5%, exceeding mortality (34.4%). Patients with T2DM had a significantly higher risk of developing neoplasms compared with patients without diabetes (32.20% versus 29.37%); similarly, patients with obesity showed an increased risk relative to those without obesity. (34.12% vs. 26.59%). HF patients with both T2DM and obesity had the highest absolute cancer risk, approximately 7% higher in absolute terms compared to HF patients without either comorbidity. Conclusions: Patients with HF carry a substantial burden of neoplastic disease, with obesity emerging as a relevant modifiable driver of increased cancer risk in this population. The coexistence of T2DM further amplifies this risk.