Cardiovascular toxicity during treatment for multiple myeloma in a real-world cohort: incidence and baseline predictors

Introduction Cardiovascular toxicity is increasingly recognised in patients receiving contemporary therapy for multiple myeloma, yet real-world estimates and predictors remain incompletely characterised. Purpose To quantify the incidence of clinically relevant cardiovascular events during anti-myeloma treatment and explore baseline factors associated with risk. Methods We performed a retrospective analysis of a real-world cohort of patients with multiple myeloma. The primary endpoint was a composite cardiovascular event occurring during treatment, defined as any of the following: heart failure, atrial fibrillation, other arrhythmias, stroke, cardiovascular hospitalisation, or cardiovascular death. Patients were considered evaluable if at least one component of the composite endpoint was recorded. Continuous variables are presented as median (interquartile range) and compared using the Mann–Whitney test; categorical variables as n (%) and compared using Fisher’s exact test. Odds ratios (OR) with 95% confidence intervals (CI) were estimated; a parsimonious logistic regression model was used for minimal adjustment. Results Among 25 evaluable patients, 10 (40.0%) experienced the composite cardiovascular endpoint. Event components included heart failure in 5/23 (21.7%), atrial fibrillation in 3/23 (13.0%), other arrhythmias in 2/23 (8.7%), stroke in 1/23 (4.3%), cardiovascular hospitalisation in 5/25 (20.0%), and cardiovascular death in 3/25 (12.0%). Baseline dyslipidaemia was more frequent in patients with events (80% vs 26.7%) and was associated with higher odds of the composite endpoint (OR 11.0, 95% CI 1.6–75.5; p=0.015). Diabetes mellitus showed a non-significant trend towards higher risk (OR 6.5, 95% CI 0.9–45.1; p=0.075). Age and baseline cardiovascular risk classification did not differ between groups. In a minimally adjusted model including dyslipidaemia and diabetes mellitus, dyslipidaemia remained associated with the endpoint with borderline significance (adjusted OR 7.6, 95% CI 1.0–59.2; p=0.053). No individual anti-myeloma treatment modality was significantly associated with the composite endpoint, including daratumumab (OR 4.00, 95% CI 0.61–26.12; p=0.182), carfilzomib (OR 2.17, 95% CI 0.24–19.28; p=0.589), lenalidomide (OR 0.75, 95% CI 0.10–5.77; p=1.000) or autologous stem cell transplantation (OR 4.67, 95% CI 0.45–48.26; p=0.345). Conclusion In this real-world cohort of patients treated for multiple myeloma, clinically relevant cardiovascular toxicity was frequent, affecting approximately two in five patients. Baseline dyslipidaemia emerged as the strongest marker of risk, supporting systematic cardiovascular risk assessment and proactive prevention strategies during myeloma therapy. Larger cohorts are warranted to confirm these findings and refine risk stratification.