Association Between Immune Checkpoint Inhibitors with Cardio
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Immune checkpoint inhibitors (ICI) treat an expanding range of cancers. Consistent basic data suggest that these same checkpoints are critical negative regulators of atherosclerosis. Therefore, the objectives were to test whether ICIs were associated with accelerated atherosclerosis and a higher risk of atherosclerosis-related cardiovascular events.

The study was situated in a single academic medical center. The primary analysis evaluated whether exposure to an ICI was associated with atherosclerotic cardiovascular events in 2842 patients and 2842 controls, matched by age, a history of cardiovascular events and cancer type.

In a second design, a case-crossover analysis was performed with an "at-risk period" defined as the two-year period after and the "control period" as the two-year prior to treatment. The primary outcome was a composite of atherosclerotic cardiovascular events (myocardial infarction, coronary revascularization and ischemic stroke). Secondary outcomes included the individual components of the primary outcome. Additionally, in an imaging sub-study, the rate of atherosclerotic plaque progression was compared from before and after starting an ICI.

Results:
-- In the matched cohort study, there was a 3-fold higher risk for cardiovascular events after starting an ICI.

-- There was a similar increase in each of the individual components of the primary outcome.

-- In the case-crossover, there was also an increase in cardiovascular events from 1.37 to 6.55 per 100 person-years at two years.

-- In the imaging study, the rate of progression of total aortic plaque volume was more than 3-fold higher with ICIs.

-- This association between ICI use and increased atherosclerotic plaque progression was attenuated with concomitant use of statins or corticosteroids.

Conclusively, Cardiovascular events were higher after initiation of ICIs, potentially mediated by accelerated progression of atherosclerosis. Optimization of cardiovascular risk factors and increased awareness of cardiovascular risk, prior to, during and after treatment, should be considered among patients on an ICI.

Source: https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.120.049981
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