Tamoxifen‐treated breast carcinoma patients and the risk of acute myocardial infarction and newly‐diagnosed angina

Abstract

BACKGROUNDIt is known that tamoxifen therapy favorably affects blood cholesterol levels and other cardiovascular disease risk factors; however, to our knowledge, few studies to date have reported a lower risk of heart disease for breast carcinoma patients who are treated with tamoxifen.METHODSA nested, matched, case–control study design was used with data from the General Practice Research Database to examine whether patients with breast carcinoma who had been treated with tamoxifen were at reduced risk of having a first acute myocardial infarction (MI) or of developing angina compared with unexposed women. All women between age 30 years and age 85 years who had been diagnosed with breast carcinoma and treated with tamoxifen, or who had been diagnosed with carcinoma of the bladder or colorectum, or nonmelanoma skin cancer between January 1991 and December 1999 were identified. From this population, all women were identified who had newly diagnosed acute MI or angina that occurred at least 1 year after their cancer diagnosis. Four female control participants were matched to each case based on age (± 1 year), date of MI or angina diagnosis (corresponding date for matched controls), and date of cancer diagnosis (± 6 months). Odds ratios (ORs) and 95% confidence intervals (95% CIs) were generated using conditional logistic regression, controlling for the matching factors, and adjusting for important risk factors, including body mass index, use of hormone replacement therapy, smoking status, and treated hypertension.RESULTSCurrent users of tamoxifen had a reduced rate ratio of acute MI or angina (adjusted OR, 0.4; 95% CI, 0.2–0.7) compared with nonusers. The effect persisted with increasing cumulative dose and length of use.CONCLUSIONSThe treatment of breast carcinoma with tamoxifen was found to reduce a woman's risk of acute MI or angina during the 5 years of recommended therapy. Cancer 2005. © 2005 American Cancer Society.

Estrogen Receptor Genotypes, Menopausal Status, and the Lipid Effects of Tamoxifen

“…Contrary to results regarding estrogen administration, most, but not all studies of tamoxifen, have shown a positive cardioprotective effect, and none have shown a deleterious effect. 4,35,36 It is of note that a large study on the effects of another selective ER modulator, raloxifene, 37 on cardiovascular outcomes showed no effect, further illustrating the complexity of the interaction between ERactive agents and overall cardiovascular effects. This complexity emphasizes the value of future research in this area as do a number of limitations of this study.…”

Tamoxifen Treatment in Danish Breast Cancer Patients and 5-Year Risk of Arterial Atherosclerotic Events: A Null Association

“…One earlier study reported a protective association between current tamoxifen and the occurrence of treated angina pectoris or myocardial infarction (odds ratio, 0.4; 95% CI, 0.2-0.7; ref. 13). However, this study compared breast cancer patients versus women with other cancers; our large cohort allowed comparison of breast cancer patients on tamoxifen with breast cancer patients not on tamoxifen.…”

Appraising Adjuvant Aromatase Inhibitor Therapy

“…Thus, the treatment of breast cancer patients with TAM might be expected to reduce rates of chronic heart disease www.TheOncologist.com compared with placebo. While this cardioprotective effect of TAM has been documented in most trials [62][63][64], it has not been observed in others [3,9,65]. However, two large meta-analyses have confirmed the cardioprotective effects of TAM.…”

“…TAM therapy not only improves lipid profiles but also reduces coronary plaques in vivo, reduces C-reactive protein, and modulates nitric oxide production [12,62]. Thus, the treatment of breast cancer patients with TAM might be expected to reduce rates of chronic heart disease www.TheOncologist.com compared with placebo.…”