Heart failure is a big problem, affecting about 65 million people around the world.

If you’re one of them, your heart isn’t pumping as well as it should and, as a result, your cells don’t receive enough blood and oxygen. This can lead to fatigue, shortness of breath and, sometimes, coughing. Simple activities like walking, climbing stairs or even carrying grocery bags can be difficult.

But that’s not all. A German study has found that people with heart failure are also more likely to develop certain cancers than those without this cardiac condition.

It is common for cancer patients who have received heart-damaging drugs to be monitored for heart failure, But heart patients should also be monitored for cancer.

A weakening of the heart can be one of the consequences of cancer treatment, but this research points to a different relationship. Heart failure patients have an increased risk of several kinds of cancers, particularly lip, oral cavity and pharynx cancers, the study found. It also reported that respiratory organ cancer, female genital organ cancer, skin tumors and other cancers were also more common.

The researchers followed more than 200,000 people — 110,124 patients with heart failure and 100,124 without — over ten years. Patients were matched by sex, age (the average age was 72.6 years) and conditions such as obesity and diabetes, as well as the frequency they consulted a medical provider. Over the decade, the incidence of cancer in heart failure patients was 25.7 percent. Those who had not suffered heart failure had only a 16.2 percent risk.

“Our results [suggest] that there may be a causal relationship between heart failure and an increased rate of cancer,” the study’s lead author, Mark Luedde of the Christian-Albrechts-University of Kiel and Cardiology Joint Practice in Bremerhaven, Germany, said in a statement. “[T]here is…evidence that factors secreted by the failing heart may stimulate tumor growth.”

The research took into account certain risk factors such as obesity and diabetes, but it’s important to note that information on whether participants smoked, their alcohol consumption or their daily physical activity — all factors that can influence both risks for developing heart failure and cancer — was not included.

The findings, even with these shortcomings, offer information that doctors can use when treating patients with heart failure. “It is common practice for cancer patients who have received heart-damaging drugs to be monitored for heart failure,” Luedde said. But the opposite is also true: “…[E]vidence is accumulating to indicate that heart failure patients could benefit from intensive monitoring for cancer development...”

The best way to protect your heart and avoid the risk of the cancers that appear to be associated with heart disease is to do what you can to prevent heart problems in the first place. These lifestyle choices, recommended by the American Heart Association, include:

  • Don’t smoke. If you do smoke, get help to quit.
  • Eat a healthy diet with nutrient rich foods including plenty of vegetables, fruits and whole grains; also, low-fat dairy products, poultry, fish, legumes, non-tropical vegetable oils (like olive oil) and nuts. Limit sweets and red meat.
  • Maintain a healthy weight.
  • Keep alcohol consumption in check. If you do drink, limit your consumption to no more than two drinks per day for men and no more than one drink for women.
  • Find ways to reduce stress.
  • Monitor your blood pressure. Ideally, it should be between 90/60mmHg and 120/80mmHg.
  • Get at least 30 minutes of moderate physical exercise daily.

The study appears in the journal, ESC Heart Failure.