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Cardiovascular events after the initiation of immune checkpoint inhibitors

Yuta Suzuki1,2, Hidehiro Kaneko1,3, Yuichi Tamura4

  • 1The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.

Heliyon
|May 30, 2023
PubMed

Insights

Immune checkpoint inhibitors (ICIs) can cause major adverse cardiac events (MACE), including heart failure, particularly within 180 days of treatment initiation. Cardiovascular monitoring is crucial for cancer patients receiving ICIs.

Area of Science:

  • Cardiology
  • Oncology
  • Immunology

Background:

  • Immune checkpoint inhibitors (ICIs) are increasingly used in cancer therapy.
  • Cardiovascular adverse events are a known but not fully characterized complication of ICI treatment.
  • Understanding the incidence of major adverse cardiac events (MACE) is critical for patient safety.

Purpose of the Study:

  • To determine the incidence of MACE following the initiation of ICI therapy.
  • To identify specific cardiovascular events associated with ICI use.
  • To analyze the timing and continuation rates of ICI treatment after MACE.

Main Methods:

  • Analysis of the JMDC Claims Database (2005-2021).
  • Inclusion of 2972 patients without prior cardiovascular disease receiving ICIs.
  • Primary outcome: incidence of MACE (myocarditis, pericarditis, Takotsubo cardiomyopathy, atrio-ventricular block, heart failure, myocardial infarction, stroke).

Main Results:

  • The overall incidence rate of MACE was recorded.
  • Specific event rates per 10,000 person-years included heart failure (1191.2), stroke (278.5), and myocardial infarction (55.2).
  • Cardiovascular events occurred more frequently within 180 days of ICI initiation; ICI continuation post-MACE was 38.4%.

Conclusions:

  • ICI treatment is associated with a notable incidence of MACE, with heart failure occurring more frequently than anticipated.
  • The timing of MACE suggests a need for vigilant cardiovascular monitoring early in ICI therapy.
  • Low ICI continuation rates post-MACE highlight potential treatment modifications and the importance of proactive cardiovascular risk management in oncology patients.
Keywords:
CancerCardiovascular diseaseImmune checkpoint inhibitorsImmune-related adverse events

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