TY - JOUR
T1 - Atherosclerotic Cardiovascular Events in Cancer Patients Treated With Immune Checkpoint Inhibitors
T2 - A Retrospective Cohort Study
AU - Tan, Sean
AU - Spear, Ella
AU - Sane, Nikhita
AU - Chan, Jasmine
AU - Nelson, Adam J.
AU - Alamgeer, Muhammad
AU - Nerlekar, Nitesh
AU - Segelov, Eva
AU - Nicholls, Stephen J.
N1 - Funding Information:
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. S.T. is supported by a Postgraduate Scholarship from the National Health and Medical Research Council of Australia, a PhD Scholarship from the National Heart Foundation of Australia , and an Australian Government Research Training Program Scholarship. A.J.N. is supported by a Postdoctoral Fellowship from the National Heart Foundation of Australia .
Publisher Copyright:
© 2023 The Authors
PY - 2024/5
Y1 - 2024/5
N2 - Background: 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. Method: 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. Results: 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<0.01) and competing risks analysis (HR 4.23; 95% CI 1.87–9.60; p<0.01). A total of 17 patients developed ASCVD events after ICI cessation (median 1.4 years). Among those with ASCVD events, 12 had prior ASCVD, 16 had hypertension, nine had hypercholesterolaemia, and four had diabetes, and nine were actively smoking. Variable prescription of cardiovascular preventative therapies was noted. Conclusions: History of ASCVD was associated with subsequent ASCVD events among patients treated with ICIs, which could occur even after active treatment was stopped. Identification and aggressive management of modifiable CVRFs should be considered throughout cancer survivorship in patients who received ICI treatment.
AB - Background: 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. Method: 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. Results: 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<0.01) and competing risks analysis (HR 4.23; 95% CI 1.87–9.60; p<0.01). A total of 17 patients developed ASCVD events after ICI cessation (median 1.4 years). Among those with ASCVD events, 12 had prior ASCVD, 16 had hypertension, nine had hypercholesterolaemia, and four had diabetes, and nine were actively smoking. Variable prescription of cardiovascular preventative therapies was noted. Conclusions: History of ASCVD was associated with subsequent ASCVD events among patients treated with ICIs, which could occur even after active treatment was stopped. Identification and aggressive management of modifiable CVRFs should be considered throughout cancer survivorship in patients who received ICI treatment.
KW - Cardio-oncology
KW - Cardiotoxicity
KW - Immune checkpoint inhibitors
KW - Immunotherapy
KW - Medical oncology
UR - http://www.scopus.com/inward/record.url?scp=85178617687&partnerID=8YFLogxK
U2 - 10.1016/j.hlc.2023.10.008
DO - 10.1016/j.hlc.2023.10.008
M3 - Article
C2 - 38042638
AN - SCOPUS:85178617687
SN - 1443-9506
VL - 33
SP - 721
EP - 729
JO - Heart Lung and Circulation
JF - Heart Lung and Circulation
IS - 5
ER -
