Cardiovascular Toxicity of BTKi in Chronic B-Cell Malignancies

Bruton's tyrosine kinase (BTK) inhibitors are important targeted drugs for treating chronic B-cell malignancies, and have played a key role in improving patient prognosis and treatment efficacy. However, despite the significant advantages of BTK inhibitors in anti-tumor therapy, the use of these drugs also promotes certain cardiovascular risks, including atrial fibrillation (AF), bleeding, hypertension, heart failure, and potential ventricular arrhythmias (VAs). The latest generation of BTK inhibitors has shown progress in reducing the incidence of these adverse events; however, cardiovascular adverse events (CVAEs) cannot be ignored and continue to pose challenges to patient safety. Therefore, determining how to optimize the clinical application of Bruton's tyrosine kinase inhibitor (BTKi) further has become an urgent problem. This review systematically analyzes the pathogenesis and clinical manifestations of BTK inhibitor-related cardiovascular complications, with a particular focus on the epidemiological characteristics and potential risk factors of common adverse reactions, such as hypertension, AF, bleeding, and stroke. Moreover, this review explores the pathological and physiological mechanisms, further evaluates the effectiveness of current risk management and intervention strategies, and proposes future research to elucidate mechanisms, optimize doses, and explore combination therapy. Meanwhile, through in-depth analysis and comprehensive evaluation of existing data, this review aims to provide a more scientific basis for clinical decision-making, while promoting research into the safety of continuous BTK inhibitor use to achieve improved treatment outcomes while balancing efficacy and safety.