A woman's heart

Abstract

Adjuvant therapy in postmenopausal women with breast cancer may contribute to the expression of underlying cardiovascular disease or expose the heart to additional toxicities. Tamoxifen remains an important component of endocrine therapy for breast cancer, although major clinical trials of the aromatase inhibitors (AIs) anastrozole, letrozole, and exemestane suggest that these agents are more effective and better tolerated alternatives to tamoxifen. The AIs inhibit the conversion of androgens to estrogen in postmenopausal women; consequently, their mechanism of action differs from that of tamoxifen. Accordingly, although it has been observed that tamoxifen has some favorable effects on cardiovascular risk, such as reducing total cholesterol levels, because of its partial estrogen‐agonist properties, no such effects exist for the AIs. Some studies, particularly those that compare the AIs with tamoxifen, have suggested a less favorable impact of adjuvant AI therapy on cardiovascular risk. Comorbid conditions, including cardiovascular disease, emerge as competing causes of death as women with breast cancer continue to live longer, and the potential impact of adjuvant therapies on cardiovascular risk becomes an increasingly important consideration for clinicians. Cancer 2009. © 2009 American Cancer Society.

Aromatase inhibitors in the breast cancer clinic: focus on exemestane

“…Consequently, among postmenopausal women, cardiovascular diseases occur more frequently (Ewer & Glück 2009). …”

Lifestyle Interventions for Cardiovascular Risk Reduction in Women with Breast Cancer

“…While the evidence for decreased estrogen levels as a cardiac risk factor, either gradually with natural menopause, abruptly with chemotherapy induced menopause or with Aromatase Inhibitor therapy is controversial, it is strongly suggested to screen and monitor peri and postmenopausal women [75-77]. In one study with pre-menopausal women diagnosed with breast cancer who experienced amenorrhea with adjuvant therapy, there was a significant change in lipids, cholesterol, LDL, HDL and Lpa [78].…”

Interpreting breast international group (BIG) 1-98: a randomized, double-blind, phase III trial comparing letrozole and tamoxifen as adjuvant endocrine therapy for postmenopausal women with hormone receptor-positive, early breast cancer

“…Patients on letrozole experienced greater incidences of vaginal dryness, bone fractures, osteoporosis, and arthralgia/myalgia (Figure 7a) and higher-grade cardiac events (Figure 7b). It is important to note that these analyses present the incidence of AEs for one regimen (letrozole) compared with the other (tamoxifen), and it is possible that tamoxifen in particular offers protection from cardiac or bone events [29,30]. The incidences of the AEs occurring in the sequential arms generally show results similar to those of the monotherapies during the time the patient was on the individual agents (that is, first 2 years or last 3 years) [12].…”