Why Cardiologists Should Care About Hematologic Diseases: A Case for Multidisciplinary Care
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Blood is moved throughout the body by the heart and a complex system of conduits in the vascular system. However, the study of blood itself and the distribution mechanisms are treated as separate fields within medicine (hematology and cardiology, respectively). Nevertheless, it is becoming increasingly more apparent that cardiovascular, hematologic, and oncologic processes have more in common than meets the eye.1 For example, light chain (AL) amyloidosis is a well-known cause of restrictive cardiomyopathy and heart failure caused by a plasma cell neoplasm.
While attending the 2021 ASH Annual Meeting this past December, I was able to enjoy connecting with old and new colleagues, and had the opportunity to hear about the latest advances in hematology and present my work. However, this time ASH felt different. Perhaps my perception has changed, as I now know I will never become a hematologist. This year, I returned to ASH as a brand-new cardiology fellow. Why would a cardiologist be so interested in hematology? Well, isn’t the function of the heart to pump blood? As I have delved into both specialties, I have realized that the division of medicine into organ-specific specialties ignores the fact that all organ systems interact with one another in order to achieve and maintain homeostasis.
I have loved studying the overlap of hematology and cardiology. My research has focused on myeloproliferative neoplasms (MPNs) and investigating mechanisms underlying thrombosis and risk factors for adverse cardiovascular outcomes. Patients with lower-risk MPNs develop cardiovascular disease, which is the most common non-MPN–specific cause of death and morbidity.2 While hematologists treat MPNs daily, cardiologists may understandably not be as familiar with these disease entities. Hematologists, likewise, are not as versed with preventative cardiology. Our work suggests that among patients with MPNs who have had heart failure hospitalizations, close follow-up with a cardiologist may confer a survival benefit.3 Additionally, we have observed that in patients with MPN and atrial fibrillation, traditional risk scores used to estimate thrombotic and bleeding risks in the general population (CHADS2VASC and HAS-BLED, respectively) may not be accurate.4 Therefore, MPNs provide a perfect example of where gaps in care and scientific inquiry exist, highlighting the importance of shared care with hematologists and cardiologists.
Cardiovascular risk stratification and management is relevant in caring for patients with many other hematologic disorders. In fact, cardio-oncology is a new and exciting field within cardiology. What about cardio-hematology? Hematologic disorders such as amyloidosis are starting to attract the attention of cardiologists and recent studies highlighting the increased cardiovascular risk in patients with clonal hematopoiesis of indeterminate potential are starting to shed light in the role of hematologic processes on cardiovascular disease.5,6 My hope is that cardio-hematology will continue to develop and drive attention to further improve the lives of patients with hematologic disorders and cardiovascular disease.
- Leiva O, AbdelHameid D, Connors JM, et al. Common pathophysiology in cancer, atrial fibrillation, atherosclerosis, and thrombosis: JACC: CardioOncology State-of-the-Art Review. JACC CardioOncol. 2021;3:619-634.
- Rungjirajittranon T, Owattanapanich W, Ungprasert P, et al. A systematic review and meta-analysis of the prevalence of thrombosis and bleeding at diagnosis of Philadelphia-negative myeloproliferative neoplasms. BMC Cancer. 2019;19:184.
- Leiva O, Bhatt A, Jenkins A, et al. Abstract 10079: Risk of cardiovascular and all-cause mortality in patients with myeloproliferative neoplasms following heart failure hospitalization. Circulation. 2021;144:A10079.
- Leiva O, Jenkins A, Rosovsky RP, et al. Abstract 10074: Cardiovascular outcomes in patients with concurrent atrial fibrillation and myeloproliferative neoplasms. Circulation. 2021;144:A10074.
- Fuster JJ, MacLauchlan S, Zuriaga MA, et al. Clonal hematopoiesis associated with TET2 deficiency accelerates atherosclerosis development in mice. Science. 2017;355:842-847.
- Jaiswal S, Natarajan P, Silver AJ, et al. Clonal hematopoiesis and risk of atherosclerotic cardiovascular disease. N Engl J Med. 2017;377:111-121.