Cardiovascular Risk Factors in Myeloproliferative Neoplasms: Associations with Survival and Thrombotic Outcomes

• CVRFs predict worse OS and thrombosis in MPNs, but not progression-free survival to MF or acute leukemia

• The hazard ratio of a CVRF on thrombosis is decreased in MPN patients compared to non-MPN controls

Cardiovascular risk factors (CVRFs) are important modifiers of thrombosis in patients with essential thrombocythemia (ET), polycythemia vera (PV) and myelofibrosis (MF). We performed a retrospective cohort analysis evaluating CVRFs in 1005 myeloproliferative neoplasm (MPN) patients from the Dana-Farber Cancer Institute (DFCI) Hematologic Malignancies Data Repository from 2014-2023. We also included a non-MPN group of 1543 age and sex-matched controls with no known diagnoses of hematologic malignancies to evaluate if CVRFs differentially impacted outcomes. CVRFs were identified through ICD codes of hypertension, hyperlipidemia, type 2 diabetes mellitus (DM2), current smoking, or BMI>30 prior to MPN diagnosis. CVRFs occurred in 34% of MPN patients. MPN patients with >1 CVRF had increased risk of death (HR 2.52; 95% CI 1.9-3.35) and arterial/venous thrombosis (HR 3.05; 95% CI 2.39-3.92). Within MPN subtypes, patients with ET, PV, and MF and CVRFs also demonstrated worse OS and thrombotic outcomes. Among CVRFs, only DM2 predicted worse thrombotic outcomes in MPN patients. The hazard ratio of a CVRF on thrombosis was decreased in MPN patients compared to non-MPN controls (HR 0.51; 95% CI 0.36-0.86). Looking at ET, PV, and MF specifically, the presence of a CVRF also had less of an impact on thrombotic risk in ET compared to controls (HR 0.35; p=0.019); no interactions between MPN diagnosis and CVRFs were seen in PV and MF patients. Our results underscore both the necessity of managing CVRFs in MPNs to improve patient morbidity and mortality, and the need to ameliorate thrombotic risk with measures beyond addressing CVRFs.