Objective:

To assess the impact of unadjusted confounding on the association between clonal hematopoiesis of indeterminate potential (CHIP) and heart failure risk after cancer treatment.

Approach:

Key Findings:

• The original study reported a subdistribution hazard ratio (sHR) of 1.26 (95% CI, 1.02-1.56) for the association between CHIP and heart failure.
• An E-value of 1.83 was calculated, indicating the strength of association needed for an unadjusted confounder to nullify the reported association.
• The E-value of 1.83 was lower than the strength of associations for adjusted covariates like hypertension (approximately 3.15), suggesting potential for substantial bias from unadjusted confounding.

Interpretation:

The association between CHIP and heart failure following cancer therapy may be influenced by unadjusted confounding factors.

Limitations:

• The original study did not adjust for several known confounders such as diabetes, HIV infection, obesity, chronic kidney disease, and cirrhosis.
• No sensitivity analyses were conducted in the original study to assess bias from unadjusted confounders.

Conclusion:

The findings indicate that the reported association between CHIP and heart failure is limited by unadjusted confounding factors.

Sources:

• Original Study by Shyr et al.
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