Association between comorbidities and major adverse cardiovascular events in patients undergoing immune checkpoint...

Cancer patients have an increased risk for cardiovascular diseases (CVDs). Conflicting information exists regarding whether cancer treatment with immune checkpoint inhibitors (ICIs) itself increases the risk for CVDs. We therefore assessed the incidence of major adverse cardiovascular events (MACE) in cancer patients treated with versus without ICIs.

One hundred fifty-eight and 163 cancer patients, treated with and without ICIs respectively, were compared. The primary endpoint was the incidence of MACE, defined as acute coronary syndrome, ischemic stroke, transient ischemic attack, new or worsening coronary artery disease or peripheral arterial occlusive disease, or cardiovascular death. We used Cox proportional hazard models and competing risk models (death), adjusted for age, sex and comorbidities (Charlson Comorbidity index, CCI) to investigate the cause-specific association between ICI-treatment and MACE.

Over a median follow-up of 30.6 months, 37 MACE occurred. The overall incidence of MACE was 14.0% in patients with and 9.3% in patients without ICI-treatment. In the multivariate analysis CCI was significantly associated with MACE (HR 1.19, 95% CI [1.03, 1.37]), whereas no association was found for ICI-treatment (HR 1.12, 95% CI [0.56, 2.22]). Competing risk analysis showed no treatment associations. CCI was associated with non-cardiovascular mortality.

We did not observe statistical evidence of an association between ICI treatment and MACE. There is evidence that a higher comorbidity burden is associated with MACE. Comorbidities are clearly associated with non-cardiovascular mortality in cancer patients. Further prospective studies are required to investigate whether treating comorbidities and optimizing cardiovascular risk factors result in improved outcomes among cancer patients.