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Associations Between Pre-Existing Cardiovascular Disease and Survival in Patients on Immune Checkpoint Inhibitor
Aditya Mahadevan1, Aidan Vosooghi2, Jagmeet Arora3
1Department of Medicine, University of California San Francisco, San Francisco, California, USA.
Patients with pre-existing cardiovascular disease (CVD) face increased mortality risk when undergoing immune checkpoint inhibitor (ICI) therapy. Conditions like heart failure and atrial fibrillation significantly impact survival outcomes in these patients.
Area of Science:
- Oncology
- Cardiology
- Immunotherapy
Background:
- The effect of pre-existing cardiovascular disease (CVD) on survival among patients receiving immune checkpoint inhibitor (ICI) therapy remains unclear.
- Understanding this relationship is crucial for optimizing patient care and predicting treatment outcomes.
Purpose of the Study:
- To investigate the association between baseline cardiovascular disease (CVD) and mortality in patients undergoing immune checkpoint inhibitor (ICI) therapy.
- To analyze the impact of specific cardiovascular conditions on survival in patients receiving ICI monotherapy or combination therapy.
Main Methods:
- Utilized the TriNetX global database, encompassing over 120 million patients.
- Identified 27,820 patients with pre-existing cardiovascular disease (CVD) before initiating ICI therapy.
- Matched these patients with an equal number of controls without pre-existing CVD.
Main Results:
- Systolic heart failure showed the highest association with mortality (HR: 1.38, 95% CI: 1.29-1.48).
- Diastolic heart failure (HR: 1.34, 95% CI: 1.27-1.42) and atrial fibrillation/flutter (HR: 1.24, 95% CI: 1.19-1.29) were also significantly linked to increased mortality.
- These associations were observed across patients receiving ICI monotherapy.
Conclusions:
- Baseline cardiovascular disease (CVD) significantly impacts mortality risk in patients undergoing immune checkpoint inhibitor (ICI) therapy.
- Incorporating CVD assessment into clinical trials can improve risk stratification and guide pretreatment strategies.
- Future research should focus on developing targeted surveillance and optimization plans for high-risk patients.
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