心血管合并症不是治疗转移性结直肠癌患者使用贝伐单抗的禁忌证。我们旨在评估治疗贝伐单抗前心血管合并症对年长转移性结直肠癌患者总生存和心血管安全的影响。从法国医保赔付数据库中提取了2009年至2015年的转移性结直肠癌患者队列（年龄≥65岁），接受首线贝伐单抗治疗。确定了基线心力衰竭、高血压和静脉/动脉血栓栓塞事件。使用Kaplan-Meier方法评估了36个月总生存率，并使用时变多变量Cox比例风险模型评估了心血管合并症对36个月总生存的影响。使用Fine and Gray模型评估了36个月心血管事件的累积发生率，以及心血管合并症对心血管事件发生的可能性的影响，以死亡作为竞争风险。我们纳入了9222名患者（56.4%男性；中位年龄73岁）。其中三分之二（66.7%）具有基线心血管合并症。心血管合并症患者和无心血管合并症患者的中位36个月总生存分别为20.4 [95%置信区间（CI）19.9-21.0]和21.8 [95% CI 21.1-22.6]个月。年龄≥75岁、日常生活能力依赖、放射治疗和另一种靶向治疗被确定为死亡风险因素，但心血管合并症不是。在36个月时，心血管事件发生在心血管合并症患者和无心血管合并症患者中的百分比分别为60.2% [95% CI 58.9-61.4]和44.1% [95% CI 42.3-45.9]。基线静脉血栓、女性、三种或更多心血管药物、另一种靶向治疗和六次以上贝伐单抗注射被确定为心血管事件的风险因素。在临床实践中，对于年长转移性结直肠癌患者在使用贝伐单抗前具有心血管合并症，其影响心血管安全，但无影响总生存。除非影响日常功能独立性，否则应密切监测心血管合并症患者的贝伐单抗治疗。© 2023. 作者，独家许可给Springer Nature Switzerland AG。

Cardiovascular comorbidities are not contraindications of bevacizumab for metastatic colorectal cancer.We aimed to evaluate the impact of cardiovascular comorbidities before bevacizumab treatment on overall survival and cardiovascular safety in older patients with metastatic colorectal cancer.A 2009-2015 cohort of patients with metastatic colorectal cancer aged ≥ 65 years administered first-line bevacizumab was extracted from the French healthcare reimbursement claims database. Baseline heart failure, hypertension, and venous/arterial thromboembolic events were identified. The 36-month overall survival rate was evaluated using the Kaplan-Meier method, and the impact of cardiovascular comorbidities on the 36-month overall survival using a time-dependent, multivariable, Cox proportional hazards model. The 36-month cumulative incidence of cardiovascular events, and the impact of cardiovascular comorbidities on the likelihood of cardiovascular events were evaluated using the Fine and Gray model, with death as a competing risk.We included 9222 patients (56.4% male; median age 73 years). Two-thirds (66.7%) had baseline cardiovascular comorbidities. The median 36-month overall survival was 20.4 [95% confidence interval (CI) 19.9-21.0] and 21.8 [95% CI 21.1-22.6] months in patients with and without cardiovascular comorbidities, respectively. Age ≥ 75 years, dependency in activities of daily living, radiotherapy, and another targeted therapy were identified as death risk factors, but not cardiovascular comorbidities. At 36 months, cardiovascular events had occurred in 60.2% [95% CI 58.9-61.4] and 44.1% [95% CI 42.3-45.9] of patients with and without cardiovascular comorbidities. Baseline venous thrombosis, female, three or more cardiovascular medications, another targeted therapy, and more than six bevacizumab injections were identified as risk factors for cardiovascular events.In clinical practice, cardiovascular comorbidities before administering bevacizumab to older patients with metastatic colorectal cancer impacted the cardiovascular safety, but not overall survival. Unless they limit functional independency, older patients with cardiovascular comorbidities should be treated with bevacizumab under close monitoring.© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.