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Vascular endothelial growth factor inhibitors (VEGFIs) have transformed treatment paradigms for several malignancies. By targeting the VEGF signalling pathway, these drugs disrupt tumour angiogenesis and can extend survival in advanced cancer settings. However, while their oncologic benefits are well recognised, VEGFIs also pose important cardiovascular (CV) risks that may be under-recognised or inadequately managed.1 Earlier clinical trials often underestimated the prevalence of cardiotoxic effects, with some reporting only single-digit percentages for heart failure events. In contrast, in real-world populations, who are often older and have more baseline comorbidities, a broader spectrum of CV injury has become apparent. Over the past decade, investigators have increasingly used structured imaging follow-up, biomarker surveillance and mechanistic studies to characterise the scope, timing and reversibility of VEGFI-related cardiotoxicity. Despite these advances, uncertainty remains regarding the optimal strategies for early detection and management.