Immune checkpoint inhibitors in cancer: the increased risk of atherosclerotic cardiovascular disease events and progression of coronary artery calcium

Immune checkpoint inhibitors (ICIs) have contributed to a significant advancement in the treatment of cancer, leading to improved clinical outcomes in many individuals with advanced cancer. Both preclinical and clinical investigations have shown that ICIs are associated with atherosclerosis and other cardiovascular events; however, the exact mechanism underlying this relationship has not been clarified. Our study included patients diagnosed with stage III or IV non-small cell lung cancer (NSCLC) at the Wuhan Union Hospital from March 1, 2020, to April 30, 2022. Coronary artery calcium (CAC) volume and score were assessed in a subset of patients during follow-up chest CT scans at baseline and 3, 6, and 12 months after treatment. The primary endpoint of this study was the occurrence of atherosclerotic cardiovascular disease (ASCVD) events, including myocardial infarction, coronary revascularization, and ischemic stroke. Secondary endpoint was the CAC progression at three time points after treatment.