Abstract 4361500: Atherosclerotic Cardiovascular Diseases, Myocarditis and Atrial Fibrillation Among Patients on Immune Checkpoint Inhibitors

Introduction: Cardiovascular events are increasingly reported in patients on immunotherapy with myocarditis being the most common. There is growing evidence suggesting that immune checkpoint inhibitors (ICIs) may accelerate atherosclerosis. Objective: The purpose of this study was to evaluate the risk of atherosclerotic cardiovascular events, myocarditis and atrial fibrillation among patients diagnosed with colon cancer treated with ICIs compared to those not treated with ICIs. Methodology: This was a retrospective cohort study conducted on TrinetX. This report was run on the set of health care organizations grouped into a network called US Collaborative Network. The study group was made up of patients with diagnosis of colon cancer who have been treated with an ICIs and the control group comprised of patients with colon cancer not treated with ICIs. Outcomes were measured up to 5 years after the index events. The primary outcomes evaluated were acute myocardial infarction, atherosclerotic heart disease, peripheral artery disease, atherosclerosis of the renal artery, internal carotid artery stenosis, cerebral infarction, myocarditis and atrial fibrillation. The two cohorts were matched for age, sex, race, hypertension, dyslipidemia, diabetes mellitus, nicotine use, obesity/overweight, family history of ischemic heart disease and exposure to chemotherapy. Risk ratios and P values were reported before and after matching. Results: The risk ratio with their corresponding P values before and after matching respectively were 1.27, P:0.0392 vs 1.06, P: 0.700 for acute myocardial infarction; 1.04, P: 0.552 vs 0.91, P: 0.916 for atherosclerotic heart disease; 0.66, P: 0.0121 vs 0.66, P: 0.053 for peripheral artery disease; 2.07, P: 0.0189 vs 0.99, P: 0.0997 for atherosclerosis of the renal artery; 0.51, P: 0.033 vs 0.59, P: 0.180 for internal carotid artery stenosis; 1.08, P: 0.553 vs 1.089, P: 0.658 for cerebral infarction; 25.04, P: <0.00001 vs 0.58/0, P: 0.001 for myocarditis;1.04, P: 0.663 vs 1.11, P: 0.426 for atrial fibrillation. Conclusion: The risk for acute myocardial infarction, atherosclerosis of the renal arteries, and myocarditis were significantly higher before matching and after matching, only the risk of myocarditis remained significantly higher in the study group compared to the control group.