Risk factors for carfilzomib-related cardiovascular adverse events in Chinese patients with multiple myeloma: A real-world retrospective cohort study

Background Although an association between carfilzomib and cardiovascular adverse events has been well documented, the risk factors for carfilzomib-induced cardiovascular adverse events in the Chinese population remain unclear. This study aimed to evaluate the incidence of and identify the risk factors for cardiovascular adverse events associated with carfilzomib in Chinese patients with multiple myeloma in a real-world setting. Methods We conducted a real-world retrospective cohort study of cardiovascular adverse events in patients with multiple myeloma treated with carfilzomib at Tianjin First Central Hospital between August 2022 and April 2026. Cardiovascular adverse events included severe hypertension, arrhythmia, heart failure, venous thromboembolism, myocardial infarction, and angina. Multivariable logistic regression was performed to identify risk factors for the development of cardiovascular adverse events during carfilzomib therapy. Results Among the 74 enrolled patients, 36 (48.6%) developed cardiovascular adverse events during carfilzomib therapy. The median time from treatment initiation to the first cardiovascular adverse event was 56 days (range, 4–559), with 67% (24/36) occurring within the first 3 months. Severe hypertension was the most common cardiovascular complication, accounting for 50% of all cardiovascular adverse events, followed by arrhythmia (47%). Multivariable analysis identified elevated baseline N-terminal pro-B-type natriuretic peptide levels as an independent predictor of subsequent carfilzomib-related cardiovascular adverse events (odds ratio, 6.16; P = 0.002). Conclusions Cardiovascular adverse events occur frequently during carfilzomib therapy in Chinese patients with multiple myeloma. Elevated baseline N-terminal pro-B-type natriuretic peptide levels may serve as an important biomarker for predicting the risk of cardiotoxicity. Patients at high risk, particularly those with elevated baseline N-terminal pro-B-type natriuretic peptide levels, may therefore require close cardiovascular monitoring throughout the course of carfilzomib treatment.