Myeloproliferative neoplasms (MPNs), previously called myeloproliferative disorders, are diseases that affect the body’s blood cells. These blood cancers sometimes lead to complications — second conditions that develop after a person is diagnosed with or treated for a first condition. MPNs can increase a person’s risk of developing several different health problems, including cardiovascular (heart and blood vessel) problems.

The three classic types of MPNs can all lead to cardiovascular problems. Cardiovascular complications occur in the following percentages of people:

• Myelofibrosis (MF) — 66.4 percent
• Polycythemia vera (PV) — 59.6 percent
• Essential thrombocythemia (ET) — 56.6 percent

It is important to remember that heart problems are also fairly common in people without MPNs. Risk of heart disease increases with age. However, people with MPNs are more likely to experience heart problems compared with people of the same age who don’t have an MPN.

To learn more, myMPNteam spoke with Dr. Ruben Mesa, a physician specializing in hematology and oncology and an MPN expert. Dr. Mesa is the director of the University of Texas Health San Antonio MD Anderson Cancer Center.

Heart Problems: An Overview

Heart disease includes any disorder that affects the heart or blood vessels. The most common type of heart disease is coronary artery disease (CAD). During this condition, plaque builds up in the blood vessels, making it harder for the arteries to carry blood around the body. Eventually, CAD can lead to a heart attack or stroke.

Other types of cardiovascular problems that may affect people with MPNs include:

• Heart attacks (a condition in which blood flow to the heart is suddenly blocked, causing damage to the heart muscle)
• Stroke (a condition in which a blood vessel carrying blood and oxygen to the brain is blocked or bursts)
• Pulmonary embolism (a blood clot that blocks arteries in the lungs)
• Pulmonary hypertension (high blood pressure within the blood vessels that connect the heart and the lungs)
• Arrhythmias (changes in the heart’s rhythm)

Why Do Heart Conditions Develop?

Scientists are studying why MPNs sometimes lead to cardiac complications. “We don’t think that MPNs directly harm the heart, in terms of weakening the heart or causing vascular disease,” said Dr. Mesa. Instead, MPNs can cause other problems, including blood clots, bleeding problems, and anemia, which can lead to a high risk of heart problems.

Blood clotting and bleeding problems can arise because of abnormal platelet levels. Platelets are tiny blood cells that form clots and prevent bleeding when a blood vessel has been injured. ET and PV usually lead to overproduction of platelets. Primary myelofibrosis (PMF) can lead to either thrombocytosis (too many platelets) or thrombocytopenia (too few platelets).

MPNs increase a person’s risk of developing thrombosis (abnormal blood clots) that prevent blood from moving normally through the arteries and veins, leading to blocked blood vessels. These blood clots can cause a heart attack, stroke, or pulmonary embolism. MPNs can also cause bleeding problems, including frequent bruising, cuts that don’t stop bleeding, nosebleeds, heavy menstrual periods, and blood in the urine or stool.

Myelofibrosis often leads to anemia (low red blood cell counts). Anemia can cause heart problems such as arrhythmia, an enlarged heart, or heart failure.

It’s not always clear why MPNs are linked to problems with the heart and blood vessels. One possibility is that inflammation throughout the body causes both MPNs and cardiovascular disease.

Can Heart Disease Be Prevented?

There’s no way to guarantee that you won’t get heart disease. However, Dr. Mesa pointed out that everyone, including those with and without MPNs, has both genetic and environmental factors that help determine risk.

“We all have a tendency that is genetically based, that can be influenced by lifestyle or other factors, to develop potentially some degree of cardiovascular disease,” he said. “Both things are important in terms of general health — diet, exercise, all these things … are relevant probably for many diseases.”

Lifestyle Changes

While you can’t change your genes, you can control lifestyle factors that may contribute to heart disease. A poor diet and a lack of physical activity can increase your chances of developing heart disease.

In order to minimize risk of cardiovascular complications, try making certain lifestyle changes:

• Choose more vegetables, fruits, and whole grains, which contain beneficial nutrients like fiber, vitamins, and minerals.
• Eat less saturated fats and trans fats, which are often found in foods like red meat, poultry with skin, high-fat dairy products, processed food, and fast food.
• Follow a low-salt diet.
• Limit how much alcohol you drink.
• Achieve and maintain a healthy weight level.
• Quit smoking.

People worried about heart problems may also want to try getting more physical activity each day. This doesn’t mean you need to perform an intense workout — lighter activity, including going on a walk or standing more throughout the day, can help. Start small and gradually work up to doing more.

Be sure to talk to your doctor before starting a new exercise program. It may not be a good idea to get a lot of physical activity if you have just undergone surgery, have red or white blood cell counts that are too low, or are at risk for certain heart complications.

Treating Other Health Problems

Other health conditions also affect your chances of developing heart problems. Dr. Mesa noted, “It’s true as well that other factors, such as control of cholesterol, control of hypertension (if it exists), clearly if diabetes exists, good control of diabetes — all of these are all very relevant.”

High cholesterol levels and hypertension (high blood pressure) are two of the main risk factors for developing cardiovascular disease. Additionally, those who have diabetes have a 2 to 4 times greater risk of developing heart problems.

If you have been diagnosed with any of these health conditions, work with your health care team to manage them. For some people, lifestyle changes alone can help treat high cholesterol, high blood pressure, and diabetes. For others, medication may be necessary. Effectively treating these conditions can help reduce your risk of cardiac complications while living with an MPN.

Treating Heart Problems and MPNs

The exact treatment you need depends on what kind of heart condition you have. Cardiovascular problems are treated by cardiologists (doctors who specialize in heart problems). If you see a cardiologist, make sure they know about your MPN diagnosis and treatments.

Having heart problems may limit your MPN treatment options. For example, people who have heart arrhythmias should not take Agrylin (anagrelide). Additionally, a person needs to have a healthy heart in order to be a candidate for a stem cell transplant.

Recognizing Serious Complications

People with MPNs and their caregivers should be aware of the signs of cardiovascular complications like heart attack, stroke, and pulmonary embolism. These conditions are medical emergencies and require immediate care.

Signs and symptoms of serious complications include:

• Heart attack — Feelings of pain or discomfort in the chest, shortness of breath, lightheadedness, nausea, or pain in the arm, shoulder, jaw, or neck
• Stroke — Weakness or numbness on one side of the body, drooping on one side of the face, severe headache, speaking problems, vision problems, confusion, dizziness, or loss of balance
• Pulmonary embolism — Shortness of breath, coughing, blue skin, sweating, fast heart beat, dizziness, or pain in the chest, arm, shoulder, jaw, or neck

If you notice any of these symptoms, seek emergency medical care right away.

Talk With Others Who Understand

On myMPNteam, the social network for people living with myeloproliferative neoplasms and their loved ones, more than 2,000 members come together to ask questions, give advice, and share their stories with others who understand life with MPNs.

Are you worried about heart problems while living with an MPN? Share your experience in the comments below, or start a conversation by posting on your Activities page.