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However, long-term use of TKIs, particularly second-generation (e.g., nilotinib) and third-generation (e.g., ponatinib) drugs, has led to adverse cardiovascular events (CV-AEs). CV-AEs pose a critical challenge to patients\u2019 long-term quality of life and treatment adherence. This narrative review systematically elucidates the complex mechanisms underlying TKI-induced cardiovascular toxicity and proposes the \u201cMetabolism-Endothelium-Thrombosis Axis\u201d as a unifying conceptual framework, integrating endothelial dysfunction, metabolic impairment, oxidative stress, inflammatory responses, and abnormal platelet activation into a coherent pathophysiological cascade. These mechanisms collectively contribute to a spectrum of clinical phenotypes. At the clinical management level, identifying individuals at high risk is crucial. Multiple risk prediction models demonstrate predictive value for CV-AEs, particularly arterial occlusive events (AOEs). Future research should focus on elucidating TKI-specific toxicity pathways, validating and optimizing risk prediction models, and exploring effective cardioprotective strategies. 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