Hematology · Medical Literature
Excess risk for cardiovascular and noncardiovascular comorbidities and multimorbidity among patients with myelodysplastic syndrome: A systematic review and meta-analysis.
Abstract
The authors performed a systematic review and meta-analysis to estimate the prevalence of comorbidities among patients with myelodysplastic syndrome (MDS) by pooling results from 28 studies and 71,400 patients. In conducting this research, the authors observed that individuals with MDS have a high rate of cardiovascular disease that is 6.2 times greater than that in the general population. A remarkably high prevalence of heart failure (between 10.4% and 18.6%) was observed, indicating that heart failure is a major issue that warrants urgent attention in MDS. The prevalence of chronic kidney disease, chronic liver disease, and solid tumors was also higher in patients with MDS. The results of this analysis indicate a much higher prevalence of multimorbidity in patients who have MDS compared with the general population (79.1% vs. 63.4%; p < .0001). Furthermore, the data demonstrate that the association between MDS and noncommunicable diseases remains strong in both high-income and low-income regions, the comorbidity burden increases with higher scores on the revised International Prognostic Scoring System, patients with multimorbidity are twice as likely to die as those without multimorbidity, and a high burden of comorbidities emerges as a common problem in MDS, occurring in 35% of patients. These findings suggest that a focus on multimorbidity and a holistic, multidisciplinary, and patient-centered approach to address the challenge of common chronic diseases could significantly improve outcomes for patients with MDS.
Clinical relevance
What is the prevalence of cardiovascular and noncardiovascular comorbidities, and the burden of multimorbidity, among patients with myelodysplastic syndrome (MDS) compared with the general population? __SNAPSHOT__ {"studyDesign":"Systematic review and meta-analysis of observational studies","setting":"International; pooled data from studies across both high-income and low-income regions; institution types not uniformly reported","sampleSize":"n = 71,400 patients with MDS across 28 included studies","population":"Adults with a confirmed diagnosis of myelodysplastic syndrome; mean age approximately 71.6 years (±5.2 years per included studies); approximately 58% male. Patients spanned a range of IPSS-R risk categories.","intervention":"Presence of MDS as the index condition; prevalence of specific comorbidities and multimorbidity ascertained at or after MDS diagnosis","comparator":"General population (sex- and age-matched where available); comparisons made for cardiovascular disease, heart failure, chronic kidney disease, chronic liver disease, solid tumors, and multimorbidity prevalence","primaryOutcome":"Pooled prevalence of cardiovascular and noncardiovascular comorbidities and multimorbidity among MDS patients compared with the general population; mortality risk associated with multimorbidity","followUp":"Not reported (cross-sectional prevalence data pooled; individual study follow-up durations varied and were not uniformly specified in the abstract)","fundingSource":"Not reported"}
Key findings
Patients with MDS demonstrated a markedly elevated rate of cardiovascular disease — 6.2 times greater than that observed in the general population (magnitude of CI and p-value not reported in the abstract). Heart failure was a particularly prominent finding, with a pooled prevalence ranging from 10.4% to 18.6%. Elevated prevalence was also documented for chronic kidney disease, chronic liver disease, and solid tumors compared with the general population, though specific effect sizes and CIs for these individual conditions are not reported in the abstract. Multimorbidity (defined as ≥2 concurrent chronic conditions) was substantially more common in MDS patients than in the general population (79.1% vs. 63.4%; p < .0001). Patients with MDS and multimorbidity had approximately twice the mortality risk of those without multimorbidity (specific HR or OR and CI not reported in the abstract). A high comorbidity burden, as measured by validated comorbidity indices, was present in approximately 35% of patients. The association between MDS and noncommunicable diseases was consistent across both high-income and low-income country settings. Comorbidity burden increased with higher revised IPSS (IPSS-R) scores. NNT/NNH: not calculable from available data. No adverse event data reported (observational design).
Practice implications
This meta-analysis establishes that MDS is associated with a substantially elevated prevalence of cardiovascular disease — particularly heart failure — as well as chronic kidney disease, chronic liver disease, and solid tumors relative to the general population. The finding that multimorbidity affects nearly 4 in 5 MDS patients and is associated with a twofold mortality increase underscores the need for systematic, multidisciplinary comorbidity assessment in this population. The results appear to apply broadly across income settings and across IPSS-R risk strata, though generalizability is limited by the heterogeneity of underlying study designs (retrospective databases, registries, single-center cohorts), which are prone to selection bias and differential ascertainment. Notably, prior work has raised concern that national healthcare databases may report nearly twice the prevalence of some comorbidities compared with MDS registries, introducing uncertainty around the true magnitude of effect. The study does not establish causality, does not demonstrate that treating comorbidities improves MDS-specific outcomes, and does not identify which comorbidity management strategies are most effective. Patients excluded from or underrepresented in the source studies (e.g., those with very low-risk MDS managed in primary care, patients in low-income countries without registry infrastructure, younger MDS patients) may not be adequately reflected. Importantly, only an abstract was available for full review; therefore, details on heterogeneity statistics, individual study quality assessment, publication bias evaluation, and subgroup analyses cannot be fully appraised. __LIMITATIONS__ Systematic review of predominantly retrospective observational studies (registries, administrative databases, single-center cohorts); causality cannot be inferred.,Substantial expected heterogeneity across pooled studies due to differing case ascertainment methods, comorbidity definitions, diagnostic coding practices, and geographic/healthcare system variation.,Prior analyses in this literature have shown that comorbidity prevalence estimates differ by nearly twofold between national healthcare databases and MDS-specific registries, raising concerns about misclassification bias in both directions.,Comorbidity data largely reflect point-prevalence at or near MDS diagnosis; longitudinal incidence data and temporal relationships between MDS and comorbidity onset are not established.,Confounding by age and sex is partially addressed by matched comparisons, but other confounders (smoking, obesity, socioeconomic status, prior therapies) are not uniformly controlled across source studies.,The 6.2-fold cardiovascular disease excess risk figure and the twofold multimorbidity-associated mortality risk are reported without confidence intervals or p-values in the abstract, limiting precise appraisal of certainty.,Funding source is not reported, precluding assessment of potential industry influence.,Full methodological details — including PRISMA adherence, GRADE assessment, publication bias testing (funnel plot/Egger's test), and sensitivity analyses — are not assessable from the abstract alone.,Generalizability to younger MDS patients, those with rare MDS subtypes, and patients in low-resource settings may be limited by underrepresentation in source studies. __BOTTOM_LINE_CATEGORY__ potentially_practice_informing __BOTTOM_LINE__ This large meta-analysis of 28 studies and over 71,400 MDS patients documents a 6.2-fold excess cardiovascular disease risk, a heart failure prevalence of 10–19%, and multimorbidity in nearly 4 out of 5 patients — with multimorbidity associated with a twofold increase in mortality. These findings support routine, structured cardiovascular and comorbidity assessment as a standard component of MDS care, with referral pathways to cardiology and other relevant subspecialties integrated into multidisciplinary management. Confirmation through prospective studies with standardized comorbidity definitions and appropriate confounding adjustment is needed before specific screening or treatment algorithms can be evidence-mandated.