Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Immune checkpoint inhibitors: acute and chronic cardiovascular complications

Immune checkpoint inhibitors (ICIs) have become a pillar of cancer therapy. The cardiovascular complications of ICIs extend beyond myocarditis and can involve any component of the cardiovascular system, including the pericardium, coronary arteries and conduction system. Clinicians caring for patients treated with ICIs must be vigilant for the cardiovascular complications of these therapies, which might portend a poor prognosis.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Get just this article for as long as you need it


Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Pathophysiology of ICI-mediated atherosclerosis.


  1. Haslam, A., Gill, J. & Prasad, V. Estimation of the percentage of US patients with cancer who are eligible for immune checkpoint inhibitor drugs. JAMA Netw. Open 3, e200423 (2020).

    Article  Google Scholar 

  2. D’Souza, M. et al. The risk of cardiac events in patients receiving immune checkpoint inhibitors: a nationwide Danish study. Eur. Heart J. 42, 1621–1631 (2021).

    Article  Google Scholar 

  3. Johnson, D. B. et al. Fulminant myocarditis with combination immune checkpoint blockade. N. Engl. J. Med. 375, 1749–1755 (2016).

    Article  Google Scholar 

  4. Tawbi, H. A. et al. Relatlimab and nivolumab versus nivolumab in untreated advanced melanoma. N. Engl. J. Med. 386, 24–34 (2022).

    Article  CAS  Google Scholar 

  5. Mahmood, S. S. et al. Myocarditis in patients treated with immune checkpoint inhibitors. J. Am. Coll. Cardiol. 71, 1755–1764 (2018).

    Article  CAS  Google Scholar 

  6. Ball, S. et al. Cardiovascular toxicities of immune checkpoint inhibitors. J. Am. Coll. Cardiol. 74, 1714–1727 (2019).

    Article  CAS  Google Scholar 

  7. Won, T. et al. Cardiac myosin-specific autoimmune T cells contribute to immune-checkpoint-inhibitor-associated myocarditis. Cell Rep. 41, 111611 (2022).

    Article  CAS  Google Scholar 

  8. Gong, J. et al. Pericardial disease in patients treated with immune checkpoint inhibitors. J. Immunother. Cancer 9, e002771 (2021).

    Article  Google Scholar 

  9. Vuong, J. T. et al. Immune checkpoint therapies and atherosclerosis: mechanisms and clinical implications. J. Am. Coll. Cardiol. 79, 577–593 (2022).

    Article  CAS  Google Scholar 

  10. Drobni, Z. D. et al. Association between immune checkpoint inhibitors with cardiovascular events and atherosclerotic plaque. Circulation 142, 2299–2311 (2020).

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Kiranbir Josan.

Ethics declarations

Competing interests

T.G.N. has received consulting fees from AbbVie, Amgen, Bristol Myers Squibb, CRO Oncology, Genentech, H3 Biomedicine, Roche and Sanofi, and has received grant funding from AstraZeneca and Bristol Myers Squibb for work related to the cardiovascular complications of immune checkpoint inhibitors. K.J. declares no competing interests.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Josan, K., Neilan, T.G. Immune checkpoint inhibitors: acute and chronic cardiovascular complications. Nat Rev Cardiol 20, 73–74 (2023).

Download citation

  • Published:

  • Issue Date:

  • DOI:


Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing