Cardiovascular outcomes with endocrine therapy
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Cardiovascular outcomes with endocrine therapy Although there appears to be a higher risk of cardiovascular disorders in postmenopausal women treated with aromatase inhibitors (AIs) rather than tamoxifen following a diagnosis of breast cancer, according to study results reported in Heart, the outcome appears to be "driven by protective effects of tamoxifen , rather than cardiotoxic effects of AIs". The prospective cohort studies involved 10 005 women from the UK and 22 027 women from the USA. The proportion of patients who initially received tamoxifen vs an AI was 47% vs 53% and 10% vs 68%, respectively; 22% of patients in the USA study did not receive any endocrine therapy. The risk of venous thromboembolism (VTE) was lower in AI recipients compared with tamoxifen recipients, both in the UK (adjusted hazard ratio [HR] 0.82; 95% CI 0.61, 1.10) and the USA (HR 0.81; 0.59, 1.09). For heart failure (HF), there was a significantly higher risk in AI recipients in the UK (HR 1.68; 1.24, 2.26), but not in the USA (HR 0.96; 0.83, 1.12). For other cardiovascular disorders, there was consistently higher risk in both countries for AI users (HR 1.29–3.25). Compared with endocrine therapy-unexposed patients, the VTE risk was higher in endocrine therapy recipients, particularly tamoxifen recipients (HR 1.39; 0.998, 1.98). For most other cardiovascular disorders, risks were significantly lower in tamoxifen recipients (HR 0.37–0.87) and tended to be lower in AI recipients. "There is no current evidence to suggest that the cardiovascular benefits of tamoxifen outweigh the far superior effect that AIs have on breast cancer recurrence in this population", note the authors, "and there is no higher cardiovascular risk when prescribing AIs to these patients". They conclude that "these results should allay any concerns about postulated cardiotoxicities of AIs, and modifications to clinical practice could reduce the risk of patients being prescribed inappropriate endocrine therapies". Matthews AA, et al. Endocrine therapy use and cardiovascular risk in postmenopausal breast cancer survivors. Heart : 11 Nov 2020. Available from: URL: http:// doi.org/10.1136/heartjnl-2020-317510
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Reactions 28 Nov 2020 No. 1832
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