Immunotherapy and the heart: Understanding the cardiovascular risks of immune checkpoint inhibitors

The advent of immune checkpoint inhibitors (ICIs) has revolutionized cancer therapy, offering improved survival outcomes in various malignancies. However, their use is associated with immune-related adverse events (irAEs), including severe cardiovascular complications. Initially considered a rare and highly fatal condition, ICI-related myocarditis was first recognized in 2016, when Johnson et al. reported an incidence of 0.09 % with 50 % mortality among patients treated with ICIs. Over time, growing awareness, early detection, and advancements in treatment have led to a significant reduction in mortality, with recent studies reporting rates as low as 7 % and lower. Importantly, it is now recognized that myocarditis is not the only cardiovascular adverse event (CVAE) related to ICIs. The spectrum of CVAEs has expanded to include conditions such as pericarditis, non-inflammatory left ventricular dysfunction, acute coronary syndrome, and arrhythmias, among others. This review aims to provide an overview of the current understanding of ICI-mediated cardiovascular adverse effects, highlighting diagnostic challenges, therapeutic strategies, and future directions for research.