Patients with chronic myeloid leukemia (CML) who are treated with certain tyrosine kinase inhibitors (TKIs) may have a greater risk for adverse cardiovascular events. But healthcare providers do not have a standardized method for assigning a cardiovascular risk stratification to those patients.

A team of Australian researchers  conducted a retrospective study of patients receiving TKI therapy to analyze the possible utility of incorporating baseline risk factors and coronary artery calcium scoring (CACS) into an assessment. Their findings were published in the Internal Medicine Journal.

Cardiovascular risk was determined in accordance with age, prior cardiovascular disease (CVD), and the Framingham Risk Score (FRS), a well-known tool already used to stratify patients into low, intermediate, and high risk of adverse cardiovascular events over 10 years based on factors such as high blood pressure and high cholesterol. They chose to incorporate CACS because it is already recommended for intermediate FRS risk and has shown promise in patients with CML.

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The researchers identified 88 patients, of whom 66 were aged 30 to 75 with no prior cardiovascular disease. The patients who were evaluated had been taken from a pool of patients who had been treated with any TKI between January 2005 and April 2020.

They were able to evaluate the FRS of 62 patients and determined that the 10-year risk of major adverse cardiovascular events (MACE) was 0 in the patients assigned to the low-risk category. Meanwhile, patients in the intermediate-risk category were found to have a 10-year MACE risk of 10%, which increased to 19% for the patients who were assigned to the high-risk category.

The researchers noted that “CACS also provided additional discriminative information in patients in our study with intermediate risk FRS.”  Ten of 31 patients in the intermediate risk category underwent CACS; 9 were subsequently reclassified to low-risk and 1 to high-risk. They also noted that none of the 10 patients who underwent CACS went on to experience MACE.

As a retrospective, single-center study, this project did have limitations. The patients who were included received imatinib and second-generation TKI therapy in upfront and next-line settings.

“In summary, we present a method of cardiovascular risk stratification in CML patients incorporating age, prior CVD, and FRS,” the researchers concluded. “This is the first risk stratification method described in CML applicable to patients of all ages and prior CVD status.”

Disclosure: Multiple authors declared an affiliation with a biotech, pharmaceutical, and/or device company. Please see the original reference for a full list of authors’ disclosures.


Baggio D, Tan S, Porch K, Shortt J, Ko B. Prediction of cardiovascular events in patients with chronic myeloid leukemia using baseline risk factors and coronary artery calcium scoring. Intern Med J. 2021;51(10):1736-1740.