Cardiovascular Risk Factors Increase Thrombosis, Mortality in Patients With Myelofibrosis, Other MPNs

Cardiovascular risk factors (CVRFs) that increase thrombosis and overall mortality are more prevalent in patients with myeloproliferative neoplasms (MPNs), and especially those with myelofibrosis (MF), who have increased rates of hyperlipidemia and hypertension compared with patients with essential thrombocythemia (ET) or polycythemia vera (PV), according to study results published in Blood: Vessels, Thrombosis, and Hemostasis.¹

Thrombosis is a potentially serious complication of myelofibrosis. | Image Credit: © Artur | stock.adobe.com

Managing thrombosis risk in patients with MF are pillars of optimal treatment, along with controlling bleeding. Studies have indicated that thrombosis is common across a variety of MPNs, including MF, ET, and PV, and more common in those patients when compared with the general population. CVRFs such as hypertension, hyperlipidemia, type 2 diabetes, and obesity have known effects on thrombosis in the general population, but data is unclear on the impact of CVRFs on patients with MF or other MPNs.^2,3

For patients with MF, it is critical for pharmacists and treatment providers to recognize the prevalence of thrombosis and its potential risk factors, including CVRFs. In this current study, the investigators conducted a retrospective cohort analysis of 1005 patients with MPNs to evaluate the impact of CVRFs on real-world patient outcomes. Additionally, study authors investigated the likelihood of MPN transition to conditions such as MF or acute leukemia.^1,2,3

Across the study sample, 215 patients had MF, 28 had pre-MF, 415 had ET, and 313 had PV. Patients with MF were found to be more likely to harbor at least 1 CVRF compared with those with ER, PV, and the general patient population (46% vs 34% in the general MPN population), according to the investigators. The most common CVRFs observed in the overall patient population were hypertension (21%), hyperlipidemia (16%), and having a body mass index (BMI) greater than or equal to 30 (12%). For patients with MF, these incidences were 31%, 22%, and 11% respectively.¹

Patients across all MPN disease categories who harbored at least 1 CVRF were more likely to be male and be older at diagnosis, and they also had a significantly higher likelihood of having MF (29% vs 17%, P < .001), according to the study authors. This finding is critical for pharmacists or providers who treat patients with MF or diagnose those who may have the disease, as it allows for closer monitoring of cardiovascular conditions that could contribute to thrombosis and serious complications.¹

Having 1 or more CVRF was associated with worse overall survival (OS) compared with patients without a CVRF (HR: 2.52; 95% CI, 1.9-3.35). In an interesting development, the investigators discovered a contrasting result in that MF-free or leukemia-free survival was not impacted by the presence of at least 1 CVRF. However, OS outcomes were worsened in patients harboring a CVRF with either MF, ET, or PV.¹

For patients with MF, having at least 1 CVRF predicted worse OS (HR: 1.83; 95% CI, 1.14-2.92) and higher likelihood of arterial thrombosis (HR: 2.91; 95% CI, 1.43-5.93) and combined arterial or venous thrombosis (HR 2.33; 95% CI 1.29-4.20), the investigators found. While these results predicted worse outcomes, data also indicated that the presence of at least 1 CVRF was not associated with worsened survival from venous thrombosis or leukemia in patients with MF.¹

Another notable observation made by the investigators is that, compared with control patients, patients with MF had lower rates of hypertension (31% vs 42%), type 2 diabetes (4% vs 10%), and prior arterial thrombosis (9% vs 23%). Within MF, hyperlipidemia and hypertension was associated with better outcomes; the investigators discussed how hyperlipidemia could be an indicator for use of ruxolitinib (Jakfafi; Incyte Corporation, Novartis), a common treatment for patients with MF.¹

“Our results emphasize that optimization of CVRFs remains an essential part of MPN care, although thrombotic risk remains elevated even in the absence of such risk factors,” the study authors concluded.¹

REFERENCES

1. How J, Leiva O, Redd R, et al. Cardiovascular risk factors in myeloproliferative neoplasms: Associations with survival and thrombotic outcomes. Blood Vessels, Thrombosis & Hemostasis. 2025:100051. doi:10.1016/j.bvth.2025.100051

2. Hultcrantz M, Björkholm M, Dickman PW, et al. Risk of arterial and venous thrombosis in patients with myeloproliferative neoplasms: A population-based cohort study. Ann Intern Med. 2018;168(5):317-325. doi:10.7326/M17-0028

3. Devendra KC, Falchi L, Verstovsek S. The underappreciated risk of thrombosis and bleeding in patients with myelofibrosis: A review. Ann Hematol. 2017;96(10):1595-1604. doi:10.1007/s00277-017-3099-2