Improvements in Cardiovascular Risk Management Needed for MPN

Although cardiovascular health of patients with myeloproliferative neoplasms (MPN) was relatively good, an estimated 11% to 22% of patients were not prescribed appropriate medications for management of comorbidities associated with thrombotic risk.

“These findings highlight a potential unmet need for improved cardiovascular risk management and coordination between primary and secondary care in the UK,” the study authors wrote in a poster presented at the 2021 European Hematology Association Virtual Congress.

In this retrospective cohort study, researchers assessed information from 2,477 patients with MPN (median age, 68 years; 56% women) from the Clinical Practice Research Datalink to determine the potential cardiovascular and thrombotic risk for all patients with MPN. Patients were included in this database at their first recorded diagnosis of polycythemia vera (n = 1,315), primary myelofibrosis (MF; n = 146) and essential thrombocythemia (n = 336). Some patients also had unspecified MPN (n = 680).

Researchers focused on pre-index assessments of the patients for six or more months before the first diagnosis and for at least 24 months post-index follow-up. During this time, researchers aimed to determine the epidemiological landscape of PMN, thrombotic/cardiovascular risk profiles before diagnosis, the extent of comorbidities using the Charlson score and the occurrence of thromboembolic/cardiovascular events after diagnosis.

Most patients (96.2%) had a low Charlson comorbidity score between 0 and 5. Moreover, the prevalence of MPN was 12.72 per 100,000. Authors noted that polycythemia vera was the most prevalent MPN subtype (6.75 per 100,000), followed by essential thrombocythemia (1.73 per 100,000) and MF (0.75 per 100,000). The rates of polycythemia vera and MF were consistent with other epidemiological reports from the UK, but the prevalence of essential thrombocythemia was lower than previous reports.

The most prevalent risk factors before MPN diagnosis included smoking (59.8%) and ischemic heart disease (27.7%). In contrast, few patients had hypertension (14.6%), diabetes (13.1%), dyslipidemia (12.8%) or obesity (8.8%). Patients with hypertension (88.9%), dyslipidemia (82.4%) and diabetes (77.9%) were prescribed appropriate medications for risk management. Of all the patients with MPN in this cohort, there were 325 cases of thrombosis before diagnosis, with a mean time of thrombosis to MPN diagnosis of 3,100.8 days.

After MPN diagnosis, 372 thromboembolic/cardiovascular events occurred. In particular, 214 events were observed in patients with polycythemia vera, 64 events in those with essential thrombocythemia, 9 events in patients with MF and 85 events in those with unspecified MPN. Authors noted that the most frequent thromboembolic/cardiovascular events were stroke (27.2%), deep vein thrombosis (17.7%) and myocardial infarction (14.8%). More patients with polycythemia vera had myocardial infarction (15.9%) compared with those with essential thrombocythemia (10.9%) or MF (0%).

Reference

1. Chen F, Rabe A, Were J, et al. An Epidemiological Study of the Cardiovascular Health and Thrombotic Risk Profiles of Patients with Myeloproliferative Neoplasms in Primary Care Across the United Kingdom. Presented at: 2021 European Hematologic Association Congress; Virtual. June 9-17, 2021. Abstract E1090.