Major Adverse Cardiovascular Events in Angiogenesis Inhibitor-Based Cancer Therapy: A Systematic Review and Meta-Analysis.

BACKGROUND: Angiogenesis inhibitors (AIs) are effective in cancer therapy due to their ability to suppress tumor vasculature. However, these agents are associated with significant cardiovascular toxicities, including hypertension, thrombosis, and heart failure, which may increase when combined with other cancer treatments, such as chemotherapy or immunotherapy. This meta-analysis aims to evaluate the cardiovascular adverse events linked to AIs, focusing on their types, incidence, and severity of these adverse events to provide a clearer understanding of the cardiovascular risks associated with AIs. METHODS: A systematic review was conducted for randomized controlled trials that assessed AI therapies. The data from 64 studies involving 27 639 patients were analyzed using a random-effects model. Major adverse cardiovascular events such as hypertension, thrombosis, arrhythmias, myocardial ischemia, and left ventricular dysfunction were the primary outcomes. RESULTS: The analysis revealed that AI treatment significantly increased the incidence of hypertension (relative risk [RR], 3.28 [95% CI, 2.82-4.30]), myocardial ischemia or infarction events (RR, 2.09 [95% CI, 1.05-4.17]), arrhythmia events (RR, 1.25 [95% CI, 0.90-1.74]), thrombotic events (RR, 1.46 [95% CI, 1.11-1.92]), and left ventricular dysfunction (RR, 2.00 [95% CI, 1.18-3.41]). Subgroup analyses indicated that the combination of AIs with chemotherapy or other targeted therapies heightened these risks. CONCLUSIONS: AIs significantly increase the risk of cardiovascular events in patients with cancer, particularly when combined with other treatments. Clinicians should balance the benefits and cardiovascular risks of AIs and consider strategies to reduce these adverse effects. Further research is needed to refine these insights.