Atherosclerotic Cardiovascular Events in Cancer Patients Treated With Immune Checkpoint Inhibitors: A Retrospective Cohort Study

Immune checkpoint inhibitors (ICIs) are effective therapies for numerous cancers, but have been associated with atherosclerotic cardiovascular disease (ASCVD). This study aimed to identify predictors for ASCVD events among cancer patients treated with ICIs and the cardiovascular risk factor (CVRF) c...

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Bibliographic Details
Published in:Heart, lung & circulation lung & circulation, 2024-05, Vol.33 (5), p.721-729
Main Authors: Tan, Sean, Spear, Ella, Sane, Nikhita, Chan, Jasmine, Nelson, Adam J., Alamgeer, Muhammad, Nerlekar, Nitesh, Segelov, Eva, Nicholls, Stephen J.
Format: Article
Language:English
Subjects:
Aged
Atherosclerosis - epidemiology
Cardio-oncology
Cardiotoxicity
Female
Follow-Up Studies
Humans
Immune checkpoint inhibitors
Immune Checkpoint Inhibitors - adverse effects
Immunotherapy
Incidence
Male
Medical oncology
Middle Aged
Neoplasms - drug therapy
Retrospective Studies
Risk Factors
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Summary:Immune checkpoint inhibitors (ICIs) are effective therapies for numerous cancers, but have been associated with atherosclerotic cardiovascular disease (ASCVD). This study aimed to identify predictors for ASCVD events among cancer patients treated with ICIs and the cardiovascular risk factor (CVRF) control of those who developed ASCVD. A single-centre retrospective study of 366 cancer patients who received ICIs from 2018 to 2020 was performed. Demographic, baseline CVRF, cancer history, and ICI regimen data were obtained from medical records. The primary end point of ASCVD events was defined as myocardial infarction, coronary revascularisation, ischaemic stroke, or acute limb ischaemia. Cox proportional multivariable modelling and competing risks analysis were performed to assess ASCVD predictors. Descriptive analysis was performed to describe CVRF management among those who developed ASCVD events. Over a median follow-up of 3.4 years (2.8–4.3), 26 patients (7.1%) experienced 27 ASCVD events (seven myocardial infarction, one coronary revascularisation, 13 ischaemic stroke, and six acute limb ischaemia events). There were 226 (61.8%) cancer-related deaths and no cardiac deaths. History of ASCVD before ICI initiation was independently associated with ASCVD events on traditional Cox modelling (hazard ratio [HR] 4.00; 95% confidence interval [CI] 1.79–8.91; p
ISSN:1443-9506
1444-2892
1444-2892
DOI:10.1016/j.hlc.2023.10.008