BACKGROUND AND AIMS: The effectiveness of systemic treatment in advanced 
hepatocellular carcinoma (HCC) depends on the selection of patients, management 
of cirrhosis complications and expertise to treat adverse events. The aims of 
the study are to assess the frequency and management of cardiovascular events in 
HCC patients treated with sorafenib (SOR) and to create a scale to predict the 
onset of major adverse cardiovascular events (MACE).
METHOD: Observational retrospective study with consecutive HCC patients treated 
with SOR between 2007 and 2019 in a western centre. In order to classify 
cardiovascular risk pre-SOR, we designed the CARDIOSOR scale with age, 
hypertension, diabetes, dyslipidaemia and peripheral vascular disease. Other 
adverse events, dosing and outcome data were collected during a homogeneous 
protocolled follow-up.
RESULTS: Two hundred ninety-nine patients were included (219 BCLC-C). The median 
overall survival was 11.1 months (IQR 5.6-20.5), and duration of treatment was 
7.4 months (IQR 3.3-14.7). Seventeen patients (6%) stopped SOR due to 
cardiovascular event. Thirty-three patients suffered MACE (7 heart failure, 11 
acute coronary syndrome, 12 cerebrovascular accident and 8 peripheral vascular 
ischemia); 99 had a minor cardiovascular event, mainly hypertension (n = 81). 
Age was the only independent factor associated to MACE (HR 1.07; 95% CI 
1.03-1.12; P = .002). The CARDIOSOR scale allows to identify the group of 
patients with higher risk of MACE (sHR 3.4; 95% CI 1.4-6.7; P = .04).
CONCLUSION: The incidence of cardiovascular events in HCC patients treated with 
SOR is higher than expected. Multidisciplinary approach and clinical tools like 
CARDIOSOR scale could be helpful to manage these patients.