Key result
Aromatase inhibitors linked to ~14% higher risk of CV events and increased heart failure vs tamoxifen.
Why the study?
Whether aromatase inhibitors increase the risk of cardiovascular events compared to tamoxifen in women with breast cancer remains debated.
Do aromatase inhibitors increase the risk of cardiovascular events compared to tamoxifen in post-menopausal women with breast cancer?
Cohort (n=33,946)
Do aromatase inhibitors increase the risk of cardiovascular events compared to tamoxifen in post-menopausal women with breast cancer?
Effect estimate: HR 1.14 (95% CI 1.00-1.29)
In post-menopausal women with breast cancer, adjuvant therapy with aromatase inhibitors is associated with a higher risk of heart failure and cardiovascular events compared to tamoxifen.
May warrant closer CV monitoring with aromatase inhibitors; leaves open causality and treatment implications.
BACKGROUND: Whether aromatase inhibitors (AIs) increase the risk of cardiovascular (CV) events, compared to tamoxifen, in women with breast cancer is still debated. We evaluated the association between AI and CV outcomes in a large population-based cohort of breast cancer women. METHODS: By using healthcare utilization databases of Lombardy (Italy), we identified women ≥50 years, with new diagnosis of breast cancer between 2009 and 2015, who started adjuvant therapy with either AI or tamoxifen. We estimated the association between exposure to AI and CV outcomes (including myocardial infarction, ischemic stroke, heart failure or any CV event) by a Cox proportional hazard model with inverse probability of treatment and censoring weighting. RESULTS: The study cohort included 26,009 women starting treatment with AI and 7937 with tamoxifen. Over a median follow-up of 5.8 years, a positive association was found between AI and heart failure (Hazard Ratio = 1.20, 95% CI: 1.02 to 1.42) and any CV event (1.14, 1.00 to 1.29). The CV risk increased in women with previous CV risk factors, including hypertension, diabetes and dyslipidemia. CONCLUSIONS: Adjuvant therapy with AI in breast cancer women aged more than 50 years is associated with increased risk of heart failure and combined CV events.
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Franchi et al. (2021) conducted a cohort in Breast cancer (n=33,946). Aromatase inhibitors vs. Tamoxifen was evaluated on Any CV event (HR 1.14, 95% CI 1.00-1.29). Adjuvant therapy with aromatase inhibitors was associated with an increased risk of heart failure (HR 1.20; 95% CI 1.02-1.42) and any CV event (HR 1.14; 95% CI 1.00-1.29) compared to tamoxifen.
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