The Rising Tide of CHIP: How Genetic Insights are Reshaping Cardiovascular Care
As our understanding of the genetic underpinnings of cardiovascular disease deepens, a previously overlooked condition – clonal hematopoiesis of indeterminate potential, or CHIP – is emerging as a significant, and increasingly common, risk factor. Cleveland Clinic has responded by launching a specialized CHIP Cardiology Clinic, signaling a proactive approach to managing this complex interplay between blood genetics and heart health.
Decoding CHIP: A Pre-Leukemic State with Cardiovascular Consequences
CHIP isn’t cancer, but it’s a pre-leukemic state. It occurs when blood stem cells acquire genetic mutations, leading to the expansion of abnormal cell clones. These mutations, while not immediately cancerous, have been demonstrably linked to the development of atherosclerotic and other cardiovascular diseases, including heart failure and arrhythmias. Despite this growing body of evidence, CHIP isn’t yet part of standard cardiovascular risk assessment.
The Nuance of Risk: It’s Not a One-Size-Fits-All Diagnosis
Launched in September 2025, the Cleveland Clinic’s CHIP Cardiology Clinic brings together cardiologists and hematologist-oncologists to provide coordinated care. The clinic aims to ensure that all patients diagnosed with CHIP in hematology settings receive follow-up evaluation. A key challenge lies in the complexity of assessing individual cardiovascular risk. We find over 45 known CHIP mutations, each potentially impacting cardiovascular health differently.
Applying a blanket approach to all CHIP patients is a common mistake. Different mutations appear to trigger different problems: some promote inflammation that accelerates plaque buildup, others increase the risk of blood clots, and still others are associated with immune changes and peripheral artery disease. Traditional cardiovascular risk factors – cholesterol, blood pressure, and smoking – must also be carefully considered.
“It’s not just ‘CHIP — yes or no?’” explains Dr. Ohad Oren, who heads the clinic. “There’s a lot of nuance here. This is a rapidly moving field, and most cardiologists do not have the training or the bandwidth to keep up to speed with fast-evolving genetic insights.”
Navigating Emerging Therapies: Personalized Approaches are Key
The new clinic focuses on education and counseling, helping patients understand how their specific mutation affects their health. Treatment decisions are made collaboratively, based on individual risk profiles. While research is ongoing, early studies suggest potential benefits from interventions like aspirin, vitamin C, and colchicine in certain CHIP patients, though randomized trials are still needed.
New therapies targeting CHIP-related inflammation or the mutations themselves are also in development, offering hope for more targeted treatments in the future. The clinic is expected to participate in CHIP trials, providing patients with opportunities to contribute to research and access cutting-edge therapies.
The Future of Screening: Identifying High-Risk Individuals
Currently, most CHIP diagnoses occur incidentally during leukemia evaluations. A critical question remains: which patients should be screened for CHIP, and what should clinicians look for? Dr. Oren recently published research in Circulation discussing best practices for establishing a CHIP cardiology clinic, and in JACC CardioOncol outlining best practices for cardiovascular management of CHIP patients.
“There is no guideline-endorsed indication, so the question I get when I give talks to cardiologists is ‘Which patients should I check for CHIP? What should I look for?’” Dr. Oren says. “I think this is the future, but we require more data to identify individuals who are at particularly high risk and who may benefit from such testing.”
Preparing for a Wave of CHIP Patients
The increasing prevalence of CHIP, driven by an aging population and more affordable testing, necessitates proactive preparation. “Every hematologist-oncologist is now encountering patients with CHIP in their practice,” Dr. Oren notes. “We have to put the mechanisms in place today, not wait five or 10 years, due to the fact that there’s going be a tsunami of patients and we must be one step ahead.”
Preventive cardiologists emphasize the importance of early identification and optimization of cardiovascular risk. A novel risk factor like CHIP can open new pathways to identify and address cardiovascular risk in individuals who might not otherwise be aware of their vulnerability.
Frequently Asked Questions About CHIP
What is CHIP? CHIP is a condition where genetic mutations occur in blood stem cells, increasing the risk of blood cancer and cardiovascular disease.
Is CHIP cancer? No, CHIP is not cancer itself, but it is considered a pre-leukemic state.
How is CHIP diagnosed? CHIP is typically diagnosed through blood tests that identify genetic mutations in blood stem cells.
What are the treatment options for CHIP? Treatment focuses on managing cardiovascular risk factors and monitoring for the development of blood cancer. Potential therapies include aspirin, vitamin C, colchicine, and emerging targeted treatments.
Should I be tested for CHIP? Currently, routine screening isn’t recommended, but discuss your risk factors with your doctor.
