ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Cardio-Oncology
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1633543
This article is part of the Research TopicComplex Interplay Between Lung Diseases and Multisystem Disorders: Pathogenesis, management, and OutcomeView all 10 articles
Analysis of Risk Factors for Major Adverse Cardiac Events in Patients with Multiple Myeloma
Provisionally accepted
Yu Feng
Zhou Jingjing
Shilv Chen
Li ShuoLi TianlanGao YanWang QianqianXu YujieMao ChunxiaLiu Shanshan
Huang Junxia*- The Affiliated Hospital of Qingdao University, Qingdao, China
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Objective: To identify risk factors for major adverse cardiovascular events (MACE) in patients with multiple myeloma (MM) and to evaluate the performance of an external risk-score–based stratification. Methods: We retrospectively analyzed 162 newly diagnosed MM patients treated at Qingdao University Affiliated Hospital (2017–2023). Baseline demographics, comorbidities, laboratory and echocardiographic indices, and treatment exposures were collected. MACE (heart failure, acute coronary syndrome, malignant arrhythmias, cardiogenic shock, or cardiac sudden death) were adjudicated during therapy. Multivariable logistic regression identified independent risk factors. Progression-free survival (PFS) was compared by Kaplan–Meier analysis. An externally derived 0–4 point cardiovascular risk score was applied and patients were grouped as low (0–1), intermediate (2), or high (3–4) risk. Results: MACE occurred in 31/162 patients (19.14%). Independent risk factors included age at diagnosis (OR = 1.059 per year), cigarette smoking (OR = 3.652), anthracycline exposure (OR = 5.850), and ISS stage III (OR = 2.593; 95% CI 1.108– 6.067; all P<0.05). Using the external risk score, 79, 54, and 29 patients were classified as low, intermediate, and high risk, respectively, with a stepwise rise in MACE incidence from ≈15% (low) to ≈18% (intermediate) and ≈31% (high). Discrimination of the score for MACE was modest (ROC AUC = 0.594). Patients experiencing MACE had significantly shorter PFS. Conclusion: Age, smoking, anthracycline use, and ISS stage III independently predict MACE in MM. External risk-score stratification demonstrates a clear gradient of risk but only modest discrimination, underscoring the need for prospective validation and optimization (e.g., integrating disease stage and treatment exposures). These findings support proactive cardio-oncology assessment and tailored therapy—particularly in older, smoking, ISS III, and anthracycline-treated patients.
Keywords: Multiple Myeloma, Major adverse cardiovascular events, ISS stage, Anthracyclines, Smoking, risk stratification, Cardio-oncology
Received: 30 May 2025; Accepted: 12 Sep 2025.
Copyright: © 2025 Feng, Jingjing, Chen, Shuo, Tianlan, Yan, Qianqian, Yujie, Chunxia, Shanshan and Junxia. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Huang Junxia, huangjx075@hotmail.com
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