Skip Navigation
Menu
Ideas and Opinions |17 July 2018

Clonal Hematopoiesis Confers Predisposition to Both Cardiovascular Disease and Cancer: A Newly Recognized Link Between Two Major Killers

Benjamin L. Ebert, MD, PhD; Peter Libby, MD

Article, Author, and Disclosure Information
Author, Article, and Disclosure Information
This article was published at Annals.org on 29 May 2018.
  • Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts (B.L.E.)
    Brigham and Women's Hospital, Boston, Massachusetts (P.L.)

    Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-0737.

    Corresponding Author: Peter Libby, MD, Brigham and Women's Hospital, Harvard Medical School, 77 Avenue Louis Pasteur, NRB-741-G, Boston, MA 02115; e-mail, plibby@bwh.harvard.edu.

    Current Author Addresses: Dr. Ebert: Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA 02215.

    Dr. Libby: Brigham and Women's Hospital, Harvard Medical School, 77 Avenue Louis Pasteur, NRB-741-G, Boston, MA 02115.

    Author Contributions: Conception and design: B.L. Ebert, P. Libby.

    Analysis and interpretation of the data: B.L. Ebert, P. Libby.

    Drafting of the article: B.L. Ebert, P. Libby.

    Final approval of the article: B.L. Ebert, P. Libby.

    Administrative, technical, or logistic support: P. Libby.

    Collection and assembly of data: B.L. Ebert, P. Libby.

×
FULL TEXT
Two scourges of humanity seem to have heretofore unsuspected common roots: cancer and cardiovascular disease. These seemingly disparate disorders share strong associations with aging. As we age, our cells can accumulate somatic genetic mutations, some of which are established drivers of cancer. When a hematopoietic stem cell in the bone marrow acquires certain mutations, it can gain a competitive advantage that gives rise to an expanded clone of leukocytes that circulate in peripheral blood (Figure) (1, 2). Such events are a first step down the path to hematologic cancer, such as myelodysplastic syndrome or acute leukemia. Progression to cancer generally requires acquisition of additional somatic mutations in the cells in the expanded clone of leukocytes, as depicted in the Figure.
This premalignant state for hematologic cancer, termed “clonal hematopoiesis of indeterminate potential” (CHIP), is analogous to monoclonal gammopathy of unknown significance, a premalignant state for multiple myeloma. The presence of a somatic mutation associated with hematologic cancer in the peripheral blood at a variant allele frequency of at least 2% in the absence of hematologic cancer defines CHIP.
CHIP is common. Septuagenarians have a greater than 10% chance of having such a clone, and prevalence continues to increase markedly with age (1). Persons with CHIP have a more than 10-fold increased risk for hematologic cancer, although most never develop myelodysplastic syndrome or leukemia (1, 2). After induction chemotherapy for acute myeloid leukemia, those with residual populations of peripheral blood...
FULL TEXT
PDF
Not Available
Citations
Citation

Ebert BL, Libby P. Clonal Hematopoiesis Confers Predisposition to Both Cardiovascular Disease and Cancer: A Newly Recognized Link Between Two Major Killers. Ann Intern Med. [Epub ahead of print 29 May 2018]169:116–117. doi: 10.7326/M18-0737

Download citation file:

© 2019

×
Permissions

Published: Ann Intern Med. 2018;169(2):116-117.

DOI: 10.7326/M18-0737

Published at www.annals.org on 29 May 2018

©
2018 American College of Physicians
3 Citations

Related Articles
Association of Hemoglobin A1c with Cardiovascular Disease and Mortality in Adults: The European Prospective Investigation into Cancer in Norfolk
Annals of Internal Medicine; 141 (6): 413-420
Statins and Multiple Noncardiovascular Outcomes: Umbrella Review of Meta-analyses of Observational Studies and Randomized Controlled Trials
Annals of Internal Medicine; 169 (8): 543-553
Review: Folic acid may reduce risk for CVD and stroke, and B-vitamin complex may reduce risk for stroke
Annals of Internal Medicine; 169 (8): JC44
Clinical Implications of Revised Pooled Cohort Equations for Estimating Atherosclerotic Cardiovascular Disease Risk
Annals of Internal Medicine; 169 (1): 20-29
View MoreView Less

Journal Club
Review: Folic acid may reduce risk for CVD and stroke, and B-vitamin complex may reduce risk for stroke
Annals of Internal Medicine; 169 (8): JC44
In type 2 diabetes with CVD and kidney disease, empagliflozin reduced mortality and hospitalization
Annals of Internal Medicine; 168 (10): JC52
In stable CVD, rivaroxaban plus aspirin reduced CV events and increased bleeding compared with aspirin alone
Annals of Internal Medicine; 167 (10): JC52
Evolocumab reduced CV events in patients with atherosclerotic CV disease taking high- or moderate-intensity statins
Annals of Internal Medicine; 167 (2): JC7
View MoreView Less

Related Point of Care
Prostate Cancer
Annals of Internal Medicine; 163 (11): ITC1
Care of the Adult Cancer Survivor
Annals of Internal Medicine; 158 (11): ITC6-1
View MoreView Less

Related Topics
Cardiology
Hematology/Oncology

Cardiology, Hematology/Oncology.

PubMed Articles
Risk of cardiovascular disease outcomes in primary care subjects with familial hypercholesterolaemia: A cohort study.
Atherosclerosis 2019;
The soluble receptor for advanced glycation end-products (sRAGE) has a dual phase-dependent association with residual cardiovascular risk after an acute coronary event.
Atherosclerosis 2019;
View More

Results provided by: PubMed

CONTINUE WITH LIMITED ACCESS
Annals of Internal Medicine
To receive access to the full text of freely available articles, alerts, and more. You will be directed to acponline.org to complete your registration.
×
acp link acp
silverchair link silverchair

Copyright © 2019 American College of Physicians. All Rights Reserved.

Print ISSN: 0003-4819 | Online ISSN: 1539-3704

Privacy Policy

|

Conditions of Use

This site uses cookies. By continuing to use our website, you are agreeing to our privacy policy. | Accept
×

You need a subscription to this content to use this feature.

×
PDF Downloads Require Access to the Full Article.
Annals of Internal Medicine
To receive access to the full text of freely available articles, alerts, and more. You will be directed to acponline.org to complete your registration.
×
Access to this Free Content Requires Users to be Registered and Logged In. Please Choose One of the Following Options
Annals of Internal Medicine
To receive access to the full text of freely available articles, alerts, and more. You will be directed to acponline.org to complete your registration.
×