Background and Importance Side effects of inhibitors of Bruton’s tyrosine kinase (BTK) include hypertension, arrhythmias and cardiac events. The cardiovascular risks associated with ibrutinib and acalabrutinib may vary depending on individual patient factors.

Aim and Objectives Outcome analysis of the occurrence of cardiovascular adverse events and cardiovascular risk in chronic lymphoid leukaemia (CLL) patients on treatment with BTK.

Material and Methods Observational retrospective study from January 2017 to May 2023. Clinical variables: sex, age, obesity, smoking, Eastern Cooperative Oncology Group (ECOG) scale, TP53 mutation, date of diagnosis, treatment, duration, adverse effects or dose modifications. Cardiovascular risk at baseline was obtained with the SCORE 2 (healthy patients), SCORE 2-OP (over 70 years of age), ADVANCE (diabetics) and SMART (previous cardiovascular disease) calculator. Data was obtained from oncology electronic prescription and electronic medical records. R commander was used for the statistical analysis.

Results Fifty-six patients with BTK treatment were included. 55.3% male, median age 73 (IQR 66–79). 51.7% TP53 mutation positive. Median years of diagnosis was 2014 (IQR 2010–2018). 30.3% obesity, 21.4% smokers and 16 ex-smokers. The median 10-year risk of cardiovascular events was 8.3% (IQR 4–11). At the start of treatment: 53.5% arterial hypertension, 26.7% dyslipidemia, 23.2% diabetes, 16% ischemic heart disease, 5.3% atrial fibrillation and 3.5% pulmonary embolism. 49 patients received treatment with ibrutinib (26.5% first- line) and 7 patients with acalabrutinib (85.7% first-line). The median treatment duration is 30 months (IQR 12–46). 23.2% reduced the dose and 42% discontinued treatment (25% remained in therapeutic abstinence). 24% developed some cardiovascular pathology during the course of treatment (14.2% developed major adverse cardiovascular events (MACE) with hospitalisation). The median year of treatment at which MACE developed was the second year (IQR 1–3). Statistically significant differences were found between the occurrence of MACE and sex (p=0.04), duration of treatment (p=0.02) and hypertension before starting BTK (p=0.009). 28.5% died (two patients due to MACE and one patient due to CLL progression).

Conclusion and Relevance The occurrence of MACE occurs in a modest number of patients with a low associated mortality. A statistically significant association was found with sex, duration of treatment and hypertension at the start of BTK.

Conflict of Interest No conflict of interest.