Hydroxychloroquine and the cardiovascular system: lights and shadows.
Angela Elia1, Dina Zucchi2, Giancarlo Cascarano3
1Department of Clinical and Experimental Medicine, University of Pisa, Italy.
Clinical and Experimental Rheumatology
|July 15, 2026
Summary
Hydroxychloroquine (HCQ) offers cardiovascular benefits by reducing inflammation and improving metabolic profiles in autoimmune disease patients. However, long-term use or high doses can cause rare cardiotoxicity, necessitating careful monitoring.
Area of Science:
- Cardiology
- Rheumatology
- Pharmacology
Background:
- Hydroxychloroquine (HCQ) is widely used for autoimmune diseases.
- Its cardiovascular effects are complex, presenting both benefits and risks.
Purpose of the Study:
- To review the dual cardiovascular impact of HCQ.
- Focus on cardioprotective and cardiotoxic effects in autoimmune disease patients.
Main Methods:
- Structured narrative review of literature up to March 2025.
- Included clinical trials, observational studies, mechanistic research, and reviews.
Main Results:
- HCQ shows cardioprotective effects via anti-inflammatory, antithrombotic, metabolic, and endothelial-protective mechanisms.
- Potential cardiotoxicity includes QT prolongation, conduction abnormalities, and cardiomyopathy, especially with long-term/high-dose use or in high-risk patients.
Conclusions:
- HCQ has a complex cardiovascular profile, generally cardioprotective at standard doses.
- Rare but serious cardiac adverse effects can occur in high-risk individuals.
- Risk-adapted monitoring is crucial for optimizing HCQ's benefit-risk balance.
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