{
  "abstract": "Next-generation Bruton's tyrosine kinase inhibitors (BTKis) such as acalabrutinib and zanubrutinib have improved treatment outcomes in B-cell malignancies, including chronic lymphocytic leukemia (CLL), mantle cell lymphoma (MCL), and Waldenström macroglobulinemia (WM), while reducing off-target toxicities compared to ibrutinib. However, their comparative cardiovascular safety profiles remain poorly characterized. This study evaluates real-world cardiovascular and clinical outcomes between zanubrutinib and acalabrutinib using a large multi-center database. We conducted a retrospective cohort study using the TriNetX Research Network (October 2017-December 2024) including adult patients with CLL, MCL, WM, or small B-cell lymphoma treated with zanubrutinib or acalabrutinib. Patients with prior exposure to other BTKis were excluded. After 1:1 propensity score matching, 2887 patients were included in each cohort. We assessed one-year outcomes including new-onset atrial fibrillation/flutter, cerebral infarction, hypertension, and all-cause mortality using Cox proportional hazards modeling. The rate of AF/flutter events observed in the zanubrutinib group (4.05%) was numerically lower compared to the acalabrutinib group (5.25%). Time-to-event analysis did not demonstrate a statistically significant difference in AF risk over time (HR 0.777, 95% CI 0.597-1.012; p = 0.06), which was similar in binary analysis (OR 0.761, 95% CI 0.581-0.997; p = 0.05). Cerebral infarction rates were similar between groups (1.09% vs. 1.12%), with no significant difference in time-to-event analysis (HR 0.984, 95% CI 0.596-1.626; p = 0.95) or binary analysis (p = 0.91). There was no significant difference in onset of hypertension in the zanubrutinib cohort (HR 1.199, 95% CI 0.957-1.501; p = 0.11) All-cause mortality was not statistically significant between the two groups (HR 0.865, 95% CI 0.740-1.012; p = 0.07). In this large, real-world analysis, fewer AF/flutter events were observed with zanubrutinib at one year; however, time-to-event analysis did not demonstrate a statistically significant difference in AF risk over time. Notably, hypertension, cerebral infarction, and all-cause mortality occurred at similar rates. This suggests zanubrutinib and acalabrutinib share similar cardiovascular safety profiles overall. However these findings are hypothesis-generating and require prospective validation before definitive conclusions about cardiovascular risk can be drawn.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, WV 26506, USA.",
    "Department of Medicine, West Virginia University, Parkersburg, WV 26104, USA.",
    "Department of Medicine, West Virginia University, Morgantown, WV 26506, USA.",
    "Department of Medicine, Willis Knighton Health System, Shreveport, LA 71103, USA.",
    "Department of Internal Medicine, Mamata Medical College, Khammam 507002, Telangana, India.",
    "Department of Internal Medicine, Division of Cardiology, Indiana University, Indianapolis, IN 46202, USA."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 8,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Maan Awad",
      "orcid": "0000-0001-8937-2297"
    },
    {
      "affs": [
        1
      ],
      "name": "Sunanda Tah"
    },
    {
      "affs": [
        2
      ],
      "name": "Syed Ahmad",
      "orcid": "0009-0008-4137-7935"
    },
    {
      "affs": [
        3
      ],
      "name": "Het Patel"
    },
    {
      "affs": [
        3
      ],
      "name": "Prajwal Kumsi Sreedhar"
    },
    {
      "affs": [
        4
      ],
      "name": "Shanmukh Sai Pavan Lingamsetty"
    },
    {
      "affs": [
        2
      ],
      "name": "Abdulrahman Murshid",
      "orcid": "0000-0003-3328-1526"
    },
    {
      "affs": [
        5
      ],
      "name": "Brijesh Patel"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/40tqm20j0mjgv.bib",
  "cited_by": 0,
  "doi": "10.3390/curroncol33100641",
  "fulltext_url": "https://europepmc.org/articles/PMC13703198",
  "id": "40tqm20j0mjgv",
  "issns": [
    "1198-0052",
    "1718-7729"
  ],
  "landing_url": "https://europepmc.org/article/MED/42930208",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2716|Chronic Lymphocytic Leukemia Research"
    ]
  ],
  "openalex": "W7223170209",
  "pdf_url": "https://europepmc.org/articles/PMC13703198?pdf=render",
  "pmcid": "PMC13703198",
  "pmid": "42930208",
  "published": "2026-10-21",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/40tqm20j0mjgv.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:22:01Z",
      "native_id": "MED:42930208",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42930208"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2716|Chronic Lymphocytic Leukemia Research",
      "subfield": "human-genetics"
    }
  ],
  "title": "Comparative Cardiovascular Outcomes in Acalabrutinib vs. Zanubrutinib in B-Cell Malignancies: A TriNetX Data Study.",
  "title_text": "Comparative Cardiovascular Outcomes in Acalabrutinib vs. Zanubrutinib in B-Cell Malignancies: A TriNetX Data Study.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:22:01Z",
  "url": "https://research.draconitic.com/paper/40tqm20j0mjgv",
  "venue": "Current oncology (Toronto, Ont.)",
  "versions": []
}