Potential Survival Edge in Multiple Myeloma From CV Meds

Mixed findings were seen following analyses of 5 classes of cardiovascular (CV) medications and their impact on survival and adverse events (AEs) in patients being treated for multiple myeloma (MM).¹ Improved survival outcomes but potential safety concerns were identified from using angiotensin-converting enzyme (ACE) inhibitors/angiotensin II receptor blockers (ARBs), but β-blockers, calcium channel blockers (CCBs), and statins did not exhibit any significant associations with patients’ outcomes.

Because MM primarily affects older adults, with the average age at diagnosis typically ranging from 65 to 74 years,² hypertension, hypercholesterolemia, and heart failure are frequent comorbid conditions requiring treatment of their own. These new data offer a complex picture for both patients and clinicians, and they reveal that some medications might help stave off cancer but also increase the risk of severe AEs. These results were recently published in Scientific Reports.¹

To better understand the relationship between heart health and cancer outcomes among these patients using CV medications at the start of their cancer journey, the researchers conducted a large-scale analysis of data from 3 major phase 3 clinical trials that covered 1804 patients:

• CASTOR (NCT02136134) compared daratumumab/bortezomib/dexamethasone bortezomib and dexamethasone alone in relapsed/refractory MM³
• MAIA (NCT02252172) compared daratumumab/lenalidomide/dexamethasone vs lenalidomide and dexamethasone in newly diagnosed MM⁴
• POLLUX (NCT02076009) compared daratumumab/lenalidomide/dexamethasone vs lenalidomide and dexamethasone alone in relapsed/refractory MM⁵

The outcomes of interest were overall survival (OS), progression-free survival (PFS), and severe (grade 3 or higher) AEs.¹

Key Findings

The most striking results involved ACE inhibitors and ARBs, both the most common reported heart medications (31% overall). Beta-blockers were used by 23%, statins by 21%, CCBs by 17%, and diuretics by 16%.

Patients taking ACE inhibitors and ARBs saw a 16% reduction in their risk of cancer progression (HR, 0.84; 95% CI, 0.71-0.99; P = .034) and of death (HR, 0.84; 95% CI, 0.68-1.04; P = .113), with the authors noting these results may suggest these medications have unintended anticancer properties that complement MM therapeutics.

In comparison, the risk reductions for both survival outcomes varied among the other classes:

• Beta-blockers:
  • PFS: HR, 1.00 (95% CI, 0.84-1.20; P = .963)
  • OS: HR, 0.91 (95% CI, 0.73-1.15; P = .441)
• Calcium channel blockers:
  • PFS: HR, 1.03 (95% CI, 0.85-1.25; P = .747)
  • OS: HR, 1.20 (95% CI, 0.95-1.52; P = .125)
• Diuretics:
  • PFS: HR, 0.86 (95% CI, 0.71-1.05; P = .147)
  • OS: HR, 0.95 (95% CI, 0.74-1.23; P = .722)
• Statins:
  • PFS: HR, 1.04 (95% CI, 0.87-1.24; P = .684)
  • OS: HR, 0.96 (95% CI, 0.76-1.21; P = .731)

However, with the use of ACE inhibitors/ARBs, patients were 1.45 times more likely to experience severe AEs (adjusted OR [AOR], 1.45; 95% CI, 1.06-1.97; P = .019). In particular, kidney issues were more likely to occur, with MM treatments implicated in kidney stress and reduced blood flow to those organs, as was hyperglycemia. Further, potassium imbalances were more likely to result from the use of diuretics, a class implicated in patients being 1.53 times more likely to experience severe AEs (AOR, 1.53; 95% CI, 1.01-2.34; P = .047).

Real-World Implications

The authors explain that their insights are especially critical because patients who have MM have an 84% elevated risk of CV death vs the general population.⁶ Further, daratumumab is known to exacerbate hypertension and has been linked to atrial fibrillation, cardiac failure, and coronary artery disease, and lenalidomide and bortezomib have been linked to ischemic heart disease, thrombosis, and congestive heart failure.

Still, they clarify that patients should not stop taking their medications when starting myeloma treatment, but that they and their treatment teams should be aware of the higher risk of potential issues and advocate for frequent monitoring. Clinicians may want to prioritize renal function tests, regular blood glucose monitoring, and management of fluid balance.

Limitations on these findings are the post hoc analysis design, which may have limited generalizability, and the dearth of data on types, durations, and adherence to CV drugs, which may have hindered the investigators’ ability to optimally measure their impact on MM treatment outcomes. There is also the possibility of bias.

“Further investigations and prospective studies are warranted to determine whether these findings persist in larger cohorts and to evaluate treatment outcomes in relation to comorbidity burden and healthcare management,” the authors conclude, “thereby providing a more nuanced and clinically relevant perspective.”

References

1. Abuhelwa AY, Almansour SA, Al-Ahamsi HO, et al. Cardiovascular medications and treatment outcomes in multiple myeloma: insights from phase III clinical trials. Sci Rep. Published online February 7, 2026. doi:10.1038/s41598-026-37464-4
2. What is multiple myeloma? International Myeloma Foundation. Accessed February 26, 2026. https://www.myeloma.org/what-is-multiple-myeloma
3. Addition of daratumumab to combination of bortezomib and dexamethasone in participants with relapsed or refractory multiple myeloma. ClinicalTrials.gov. Updated August 29, 2025. Accessed February 27, 2026. https://clinicaltrials.gov/study/NCT02136134
4. Study comparing daratumumab, lenalidomide, and dexamethasone with lenalidomide and dexamethasone in participants with previously untreated multiple myeloma. ClinicalTrials.gov. Updated October 25, 2025. Accessed February 27, 2026. https://clinicaltrials.gov/study/NCT02252172
5. A study comparing daratumumab, lenalidomide, and dexamethasone with lenalidomide and dexamethasone in relapsed or refractory multiple myeloma. ClinicalTrials.gov. Updated May 1, 2025. Accessed February 27, 2026. https://clinicaltrials.gov/study/NCT02076009
6. Al-Kindi SG, Oliveira GH. Prevalence of preexisting cardiovascular disease in patients with different types of cancer: the unmet need for onco-cardiology. Mayo Clin Proc. 2016;91(1):81-83. doi:10.1016/j.mayocp.2015.09.009