Cardiovascular risk in cancer patients treated with immune checkpoint inhibitors: challenges and future directions.

This review discusses atherosclerotic cardiovascular disease (ASCVD) risk in patients treated with immune checkpoint inhibitors (ICIs).

Key points:

• Cardiovascular disease is the leading cause of non-cancer mortality and morbidity in people living with or cured of cancer.
• ICIs have transformed outcomes across multiple malignancies, including metastatic disease, but their pro-inflammatory effects may increase ASCVD risk in survivors.
• Standard modifiable cardiovascular risk factors (hypertension, diabetes, dyslipidemia, smoking, etc.) are common, under-screened, and frequently undertreated in oncology populations.
• As the number of long-term ICI-treated survivors grows, systematic cardiovascular risk identification and prevention becomes increasingly important.
• The review emphasizes several practical challenges:
  • Balancing competing risks of death from cancer versus ASCVD when deciding on prevention intensity.
  • Absence of risk prediction tools tailored to patients receiving ICIs.
  • Potential interactions between cardiovascular medications and oncologic treatments.
  • Structural and workflow barriers that hinder routine cardiovascular screening and preventive care within current health systems.

Overall, the article calls for more structured cardio-oncology approaches to ASCVD prevention in patients receiving ICIs, given their improving cancer survival and potentially heightened vascular risk.