{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T06:50:58Z","timestamp":1791355858164,"version":"4.3.1"},"reference-count":20,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background &amp; Aims<\/jats:title>\n                    <jats:p>The management of comorbidities has become increasingly relevant in unresectable hepatocellular carcinoma (uHCC) as immunotherapy prolongs survival. Atezolizumab plus bevacizumab (AB) is a standard first\u2010line option, but bevacizumab carries a risk of cardiovascular toxicities. Data on cardiovascular risk stratification in patients with cirrhosis remain limited. Identifying patients at increased cardiovascular risk is therefore clinically important, particularly given the availability of bevacizumab\u2010free alternatives.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analysed prospectively collected data from the multicenter Italian ARTE database, including patients with uHCC treated with first\u2010line AB between June 2022 and July 2025. Traditional major adverse cardiovascular events (tMACE) were defined as acute coronary syndromes, heart failure, cerebrovascular events, or peripheral ischemia, while an extended composite (eMACE) additionally included venous thromboembolism and immune\u2010related myocarditis. Cardiovascular risk was stratified using the European Society of Cardiology (ESC) Cardio\u2010Oncology classification and the CARDIOSOR score. Competing\u2010risk analyses were performed considering treatment discontinuation as a competing event.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>This study included 538 patients (median age 69.8\u2009years). During follow\u2010up, 20 patients (3.7%) experienced tMACE, and 30 (5.6%) experienced eMACE. Patients assigned to the very high\u2010risk category by ESC criteria and those with a high\u2010risk CARDIOSOR score had a significantly increased risk of tMACE and eMACE. Both scores demonstrated a moderate ability to stratify cardiovascular risk (Harrell's c\u2010index 0.68 for ESC and 0.59 for CARDIOSOR).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Cardiovascular adverse events were uncommon overall, but their incidence was not negligible in patients in high\u2010risk subgroups. Risk scores may help identify vulnerable subgroups and support patient\u2010tailored treatment strategies, including consideration of bevacizumab\u2010free regimens in selected cases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>Multicenter ARTE database (NCT06806579)<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/liv.70909","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T06:06:50Z","timestamp":1791353210000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Stratifying Cardiovascular Risk in Patients With\n                    <scp>HCC<\/scp>\n                    Receiving Atezolizumab\/Bevacizumab: A Comparison of\n                    <scp>ESC<\/scp>\n                    and\n                    <scp>CARDIOSOR<\/scp>\n                    Scores"],"prefix":"10.1111","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3800-5678","authenticated-orcid":false,"given":"Bernardo","family":"Stefanini","sequence":"first","affiliation":[{"name":"Department of Medical and Surgical Sciences University of Bologna  Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9957-3615","authenticated-orcid":false,"given":"Lorenza","family":"Rimassa","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences Humanitas University  Pieve Emanuele Milan Italy"},{"name":"Hepatopancreatobiliary Oncology Unit, Humanitas Cancer Center IRCCS Humanitas Research Hospital  Rozzano Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3493-6504","authenticated-orcid":false,"given":"Massimo","family":"Iavarone","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico  Milan Italy"},{"name":"Department of Pathophysiology and Transplantation, CRC \u2018A. M. and A. Migliavacca\u2019 Centre for Liver Disease University of Milan  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0946-3859","authenticated-orcid":false,"given":"Giuseppe","family":"Cabibbo","sequence":"additional","affiliation":[{"name":"Gastroenterology and Hepatology Unit, Department of Health Promotion, Mother &amp; Child Care, Internal Medicine &amp; Medical Specialties University of Palermo  Palermo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8629-0878","authenticated-orcid":false,"given":"Fabio","family":"Marra","sequence":"additional","affiliation":[{"name":"Internal Medicine and Liver Unit University Hospital Careggi, University of Florence  Florence Italy"},{"name":"Department of Experimental and Clinical Medicine University of Florence  Florence Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caterina","family":"Vivaldi","sequence":"additional","affiliation":[{"name":"Unit of Medical Oncology 2 Azienda Ospedaliero\u2010Universitaria Pisana  Pisa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0402-4176","authenticated-orcid":false,"given":"Andrea","family":"Dalbeni","sequence":"additional","affiliation":[{"name":"Unit of General Medicine C, Medicine Department University of Verona and University and Hospital Trust (AOUI) of Verona  Verona Italy"},{"name":"Liver Unit, Medicine Department University of Verona and University and Hospital Trust (AOUI) of Verona  Verona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca Romana","family":"Ponziani","sequence":"additional","affiliation":[{"name":"Liver Unit, CEMAD Centro Malattie dell'Apparato Digerente, Medicina Interna e Gastroenterologia Fondazione Policlinico Universitario Gemelli IRCCS  Rome Italy"},{"name":"Dipartimento di Medicina e Chirurgia Traslazionale Universit\u00e0 Cattolica del Sacro Cuore  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Palloni","sequence":"additional","affiliation":[{"name":"Medical Oncology IRCCS Azienda Ospedaliero\u2010Universitaria di Bologna  Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7593-8138","authenticated-orcid":false,"given":"Sara","family":"Lonardi","sequence":"additional","affiliation":[{"name":"Oncology Unit 1 Veneto Institute of Oncology IOV\u2014IRCCS  Padua Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5133-5829","authenticated-orcid":false,"given":"Lorenzo","family":"Lani","sequence":"additional","affiliation":[{"name":"Unit of Semeiotics, Liver and Alcohol\u2010Related Diseases IRCCS Azienda Ospedaliero\u2010Universitaria di Bologna  Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0863-7546","authenticated-orcid":false,"given":"Piera","family":"Federico","sequence":"additional","affiliation":[{"name":"Oncology Unit Ospedale del Mare  Napoli Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianluca","family":"Svegliati\u2010Baroni","sequence":"additional","affiliation":[{"name":"Liver Injury and Transplant Unit Polytechnic University of Marche  Ancona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6919-1536","authenticated-orcid":false,"given":"Tiziana","family":"Pressiani","sequence":"additional","affiliation":[{"name":"Hepatopancreatobiliary Oncology Unit, Humanitas Cancer Center IRCCS Humanitas Research Hospital  Rozzano Milan 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Universitario Gemelli IRCCS  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2566-3041","authenticated-orcid":false,"given":"Pierluigi","family":"Toniutto","sequence":"additional","affiliation":[{"name":"Hepatology and Liver Transplantation Unit, Azienda Ospedaliero Universitaria University of Udine  Udine Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9875-019X","authenticated-orcid":false,"given":"Rosanna","family":"Villani","sequence":"additional","affiliation":[{"name":"Liver Unit, Department of Medical and Surgical Sciences University of Foggia  Foggia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Deiana","sequence":"additional","affiliation":[{"name":"Medical Oncology IRCCS Azienda Ospedaliero\u2010Universitaria di Bologna  Bologna 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ESC Guidelines on Cardio\u2010Oncology Developed in Collaboration With the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio\u2010Oncology Society (IC\u2010OS)","author":"Lyon A. 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