Drugs

, Volume 66, Issue 13, pp 1727–1740

Cardiovascular Health and Aromatase Inhibitors

Review Article

DOI: 10.2165/00003495-200666130-00005

Cite this article as:
Pritchard, K.I. & Abramson, B.L. Drugs (2006) 66: 1727. doi:10.2165/00003495-200666130-00005

Abstract

Cardiovascular disease is the most frequent cause of death in North American women, and so death resulting from cardiovascular disease, rather than from malignancy, is not uncommon in breast cancer patients. This may be a consequence of the shared risk factors for developing breast cancer and cardiovascular disease, as well as the difficulty of managing cancer patients at higher risk for developing cardiovascular disease. Recently, much attention has focused on understanding the cardiovascular risk factors associated with breast cancer therapies. Tamoxifen has a lowering effect on serum lipids and is reported to decrease the risk of myocardial infarction but to increase the risk of thromboembolic events. Current data indicate that aromatase inhibitors (AIs) are not associated with an increased risk of thromboembolic or cerebrovascular events. Reports of a greater incidence of hypercholesterolaemia when AIs are compared head-to-head with tamoxifen may be a result of the intrinsic lipid-lowering effects of tamoxifen therapy and may be confounded by differences in data collection among trials. The incidence of cardiovascular events associated with AIs in large trials has been reported to be higher in trials comparing AIs with tamoxifen; comparisons within the MA.17 trial, which evaluated an AI versus placebo, did not show increases in hypercholesterolaemia or in cardiovascular events with the AI.

When treating breast cancer patients, oncologists should consider the same positive lifestyle changes that are proposed to lower the risk of cardiovascular disease in patients who do not have breast cancer. Moreover, physicians should assess cardiovascular risk, and monitor and treat patients already diagnosed with or at risk for coronary heart disease, according to established guidelines.

Copyright information

© Adis Data Information BV 2006

Authors and Affiliations

  1. 1.Toronto-Sunnybrook Regional Cancer Centre, Sunnybrook Health Sciences Centre, and the University of TorontoTorontoCanada
  2. 2.Saint Michael’s Hospital and the University of TorontoTorontoCanada
  3. 3.Division of Clinical Trials and EpidemiologyToronto-Sunnybrook Regional Cancer CenterTorontoCanada