Vascular function in breast cancer survivors on aromatase inhibitors: a pilot study

Blaes, Anne; Beckwith, Heather; Florea, Natalia; Hebbel, Robert P.; Solovey, Anna; Potter, David A.; Yee, Douglas; Vogel, Rachel Isaksson; Luepker, Russell V.; Duprez, Daniel

doi:10.1007/s10549-017-4447-6

Cited by 37 publications

(46 citation statements)

References 22 publications

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“…Three studies have assessed markers of atherosclerosis and endothelial function in postmenopausal women receiving aromatase inhibitors. In a cross-sectional study, women receiving aromatase inhibitors (n = 36; mean age, 62 years) had reduced vascular relaxation and increased endothelial dysfunction assessed by several noninvasive measures, compared with age-, body mass index–, and cardiovascular risk factor burden–matched controls (n = 25) [78]. In a prospective study, women (n = 97; mean age, 66 years) initiating aromatase inhibitors were more likely to have a deterioration in their reactive hyperemia index at 12-month follow-up compared with matched controls (29% vs 11%, P = 0.04), an effect more likely in women with at least three cardiovascular risk factors [79].…”

Section: Effects Of Endocrine Therapy On Cardiometabolic Outcomesmentioning

confidence: 99%

Cardiometabolic Effects of Endocrine Treatment of Estrogen Receptor–Positive Early Breast Cancer

Cheung

Ramchand

Yeo

et al. 2019

Journal of the Endocrine Society

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Estrogen receptor–positive early breast cancer is common and has a relatively good prognosis. It shares risk factors with cardiovascular disease, and cardiovascular disease is an important competing cause of mortality. Adjuvant endocrine therapy with aromatase inhibitors (requiring concomitant ovarian suppression in premenopausal women) or selective estrogen receptor modulators (usually tamoxifen) exert oncologic benefits by respectively inhibiting estradiol synthesis or breast estrogen receptor signaling. Aromatase inhibitors cause systemic estradiol depletion. Tamoxifen has mixed agonistic/antagonistic effects in a tissue-dependent fashion. Given that estrogens modulate cardiometabolic risk, a review of the effects of endocrine therapy on cardiometabolic outcomes is pertinent. The current, but limited, evidence suggests that tamoxifen treatment, although associated with increases in body fat, hepatic steatosis, serum triglycerides, and diabetes risk, modestly reduces low-density lipoprotein cholesterol and lipoprotein(a) and may have favorable effects on markers of subclinical atherosclerosis. Tamoxifen is associated with either no effect on, or a reduction in, cardiovascular events, and it is associated with an increase in venous thromboembolic events. Aromatase inhibitors, although fewer studies are available and often confounded by comparison with tamoxifen, have not been consistently associated with adverse changes in cardiometabolic risk factors or increases in cardiovascular events. Further clinical trials designed to evaluate cardiometabolic outcomes are needed to more accurately determine the effects of endocrine therapy on cardiovascular risks, to inform individualized decisions regarding choice and duration of endocrine therapy, and to implement evidence-based strategies to mitigate cardiometabolic risks. In the meantime, although breast cancer–specific evidence for benefit of lifestyle measures is available and recommended routinely, proactive monitoring and treatment of cardiovascular risk factors should follow general population recommendations.

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Section: Effects Of Endocrine Therapy On Cardiometabolic Outcomesmentioning

confidence: 99%

Cardiometabolic Effects of Endocrine Treatment of Estrogen Receptor–Positive Early Breast Cancer

Cheung

Ramchand

Yeo

et al. 2019

Journal of the Endocrine Society

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“…44 The finding of comparable blood pressure control in cancer survivors is a significant finding given that endocrine therapies, antiangiogenic therapies, and other cancer therapies have been associated with elevated blood pressures. [45][46][47] Previous studies regarding the receipt of preventive health screenings and in particular cholesterol screening have been limited and have had conflicting results. Synder et al conducted a longitudinal study and multi-cohort study evaluating cholesterol screening and other preventive health services in Medicare recipients compared with matched controls using claims-based data and found decreased rates of screening in cancer survivors compared with controls except when a comorbidity-based cohort analysis was conducted.…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular Screening and Lipid Management in Breast Cancer Survivors

Price

Mims

Player³

et al. 2020

J Am Board Fam Med

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Background: Cardiovascular disease (CVD) is the leading cause of death among breast cancer (BC) survivors. BC survivors are at increased risk of CVD due to a higher prevalence of risk factors. Current data are limited on the cardiovascular screening practices and lipid management in this population in primary care settings. Methods: A retrospective case control study was performed with 105 BC survivors and 210 matched controls (based on age and medical comorbidities of diabetes, hypertension, and hyperlipidemia). BC survivors were established with primary care practices within a large academic institution and had completed primary cancer treatment. Data on screening for CVD and lipid management were collected via a retrospective chart review. Results: The average BC survivor was 63 years old, with 9 years since diagnosis. Compared with matched controls, BC survivors had more cholesterol screening (88% vs 70%, P < .001) and active statin prescriptions (63% vs 40%, P < .05) if indicated by the Atherosclerotic Cardiovascular Disease Calculator. There were no differences in CVD screening in White and African American BC survivors. However, African American BC survivors were more likely to have hypertension (P < .01) and have a body mass index in the overweight and obese category (P < .001) than White BC survivors. Older BC survivors were more likely to receive cholesterol screening. Discussion: This study demonstrates that BC survivors who have an established primary care provider have improved cholesterol screening and statin therapy based on their risk of developing chronic diseases.

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“…Potential subjects were mailed a letter of recruitment inviting them to participate in the study and have been previously described. 16 A follow-up phone call was placed to the subjects who did not respond. Consented subjects were invited to undergo vascular assessment and biomarker assessment.…”

Section: Methodsmentioning

confidence: 99%

“…The vascular assessment testing procedure has been previously described. 16 Testing was performed using the Endo-PAT 2000 and HDI/PulseWave CR-2000 Cardiovascular Profiling System (Hypertension Diagnostic Inc, Eagan, MN, USA). LAE and SAE are derived from the diastolic pulse contour analysis based on a modified Windkessel model of circulation (model HDI/PulseWave CR-2000 Cardiovascular Profiling System).…”

Section: Methodsmentioning

confidence: 99%

Arterial elasticity as a risk factor for early cardiovascular disease among testicular cancer survivors treated with platinum-based chemotherapy: a cross-sectional pilot study

Blaes¹,

Mulrooney²,

Solovey³

et al. 2018

VHRM

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PurposeTesticular cancer survivors who have received platinum-based chemotherapy are at risk for premature cardiovascular disease. The etiology of this risk is not well understood. This pilot study explores the impact of platinum-based chemotherapy on endothelial function.MethodsTesticular cancer survivors <30 years old at the time of diagnosis who received platinum-based chemotherapy between 2002 and 2012, as well as 17 similarly aged male controls, were identified. Consented subjects underwent vascular assessment using the HDI/PulseWave CR-2000 Cardiovascular Profiling System and the Endo-PAT2000 system. Biomarkers and functional test markers were compared among cases, controls, and a group of historical controls using two sided two-sampled t-tests and Wilcoxon rank-sum tests.ResultsThirteen survivors with a median age of 30.2 years and body mass index of 27.3 were enrolled, along with 17 healthy controls with a median age of 27.1 years and body mass index of 24.8. Median time from chemotherapy was 4.7 (range: 0.8–14) years. There was no statistical difference in reactive hyperemia peripheral arterial tonometry ratio between cases and controls (p = 0.574). There was no statistical difference in small or large artery elasticity between cases and controls (p = 0.086) or between cases and historical controls (p = 0.729). There was also no statistical difference in the blood levels of circulating endothelial cells, von Willebrand factor, and vascular cell adhesion molecules. There was a trend toward increased metabolic syndrome in cases (15%) as compared to recruited controls (6%), though this difference was not statistically significant (p = 0.565).ConclusionTesticular cancer survivors have no clinically significant difference in endothelial function compared to controls 4 years after the completion of chemotherapy. Further research is needed to explore the secondary modifiable causes that may contribute to the risk of premature cardiovascular disease.

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Vascular function in breast cancer survivors on aromatase inhibitors: a pilot study

Abstract: Vascular function changes in breast cancer cases on AIs compared to postmenopausal women. Further work is needed to evaluate vascular changes over time.

Cited by 37 publications

References 22 publications

Cardiometabolic Effects of Endocrine Treatment of Estrogen Receptor–Positive Early Breast Cancer

Cardiometabolic Effects of Endocrine Treatment of Estrogen Receptor–Positive Early Breast Cancer

Cardiovascular Screening and Lipid Management in Breast Cancer Survivors

Arterial elasticity as a risk factor for early cardiovascular disease among testicular cancer survivors treated with platinum-based chemotherapy: a cross-sectional pilot study

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