Heart Risks and MPNs: What Patients Should Know

Learn how myeloproliferative neoplasms (MPNs), especially myelofibrosis, can increase your risk of heart issues like heart failure and pulmonary hypertension. Discover what you can do to manage these risks and improve your care.

Why heart health matters for people with MPNs

Dr. Orly Leiva, an advanced heart failure and transplant fellow at the University of Chicago, has spent years studying the connection between heart health and MPNs. He shared his expertise in a recent HealthTree webinar. 

While most people associate MPNs with blood and bone marrow changes, Dr. Leiva emphasized that MPNs are whole-body conditions. Heart complications are the second most common cause of death in people with myelofibrosis, after blood-related causes. This makes heart health an essential part of MPN care.

Understanding how MPNs increase heart risks can help patients and their doctors make more informed decisions about screening and treatment. 

Blood clots and MPNs: A well-known but tricky problem

People living with MPNs, including myelofibrosis, essential thrombocythemia, and polycythemia vera, are at higher risk for blood clots, which can lead to heart attacks and strokes. In myelofibrosis, the risk remains significant despite some patients having low platelet counts, which are typically needed for clotting. 

One review of multiple studies found that 6.6% to 15.9% of people with myelofibrosis developed a blood clot within a few years. Managing this risk is challenging. Treatments like blood thinners can help, but may also increase bleeding risk.

Heart failure is more common in myelofibrosis than previously thought

Heart failure, where the heart can't pump blood efficiently, was once rarely discussed in MPN care. Dr. Leiva’s research now shows that people with myelofibrosis have higher rates of heart failure compared to those with other types of MPNs.

Symptoms include shortness of breath, swelling in the legs or abdomen, and fatigue. These signs can be confused with other MPN-related issues, like spleen enlargement, which is why cardiologist evaluations are so important.

In Dr. Leiva’s study, 17% of MPN patients had been hospitalized for heart failure, and these individuals had a higher chance of future heart issues and death. Risk factors included high white blood cell counts and large spleens—signs of more active or advanced MPNs.

These findings suggest that people with MPNs should be screened for heart failure, especially if they have symptoms.

Pulmonary hypertension may signal a worsening MPN 

Pulmonary hypertension is high blood pressure in the lungs. It causes shortness of breath, fatigue, and low oxygen levels. In myelofibrosis, Dr. Leiva’s team found that signs of pulmonary hypertension on heart ultrasound were linked with a higher chance of progression to leukemia or worsening MPN.

In one study, 50% of people with MPNs had signs of pulmonary hypertension on heart scans. Those with more advanced findings were more likely to experience major cardiovascular events or cancer progression.

These results highlight the value of screening for pulmonary hypertension in individuals showing symptoms or who are at higher risk.

What treatments may help lower heart risks?

Dr. Leiva noted that people taking ruxolitinib (Jakafi, Incyte), a treatment used for myelofibrosis, were less likely to develop heart failure or experience further heart problems. While more studies are needed, this suggests the medicine may offer heart benefits beyond cancer control.

Managing traditional heart risk factors like high blood pressure, cholesterol, and diabetes also plays a big role. Exercise, a heart-healthy diet, and regular check-ins with a cardiologist can make a difference.

For those diagnosed with heart failure, guideline-based therapies like ACE inhibitors, beta blockers, or SGLT2 inhibitors can improve symptoms and lengthen life. Some people may also benefit from devices like defibrillators or pacemakers.

Should you see a cardiologist?

Dr. Leiva recommended that MPN patients over the age of 50 see a cardiologist at least once a year, especially if they have symptoms like shortness of breath, swelling, or fatigue. Cardiologists can run tests such as echocardiograms (heart ultrasounds) to check for signs of trouble early.

This kind of care may be harder to access in smaller communities, but even one visit a year can make a difference. If available, a cardio-oncologist (a heart specialist trained in cancer-related heart issues) can offer even more targeted care.

Summary

Heart problems like heart failure and pulmonary hypertension are common and serious for people with MPNs, especially myelofibrosis. Paying attention to symptoms, managing heart risk factors, and working with a cardiologist are key steps to supporting heart health. Regular checkups and thoughtful care can help people with MPNs address these risks early. 

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