Cardiovascular Adverse Events Associated With Immune Checkpoint Inhibitors From the Perspective of Gut Microecology: Potential Roles and Research Advances of the Gut Microbiota

ABSTRACT: Immune checkpoint inhibitors (ICIs) have revolutionized cancer immunotherapy by significantly improving the prognosis of patients with various malignancies. Despite their clinical benefits, ICIs are increasingly recognized for inducing cardiovascular adverse events, including severe toxicities such as myocarditis, which pose substantial challenges in oncology practice. Emerging evidence highlights the gut microbiota as a critical regulator of host immunity, potentially influencing the development and progression of ICI-associated cardiovascular toxicities. This review comprehensively examines the current understanding of the interplay between gut microbiota and ICI-associated cardiovascular adverse events. We systematically analyze the incidence, pathophysiological mechanisms, diagnostic criteria, and prognosis of major cardiovascular toxicities linked to ICIs. Furthermore, we explore the immunomodulatory functions of the gut microbiome that may underlie these adverse events, emphasizing microbiota-mediated systemic immune dysregulation and cardiovascular-specific toxicity pathways. We also discuss future research directions and the clinical implications of integrating gut microbiota modulation into the management of ICI-associated cardiovascular complications. By synthesizing multidisciplinary insights, this review aimed to provide a theoretical foundation and research framework to advance both basic and clinical studies in this emerging field.