Key result
Aromatase inhibitors are linked to ~39% higher ischemic stroke risk versus tamoxifen.
Why the study?
The target population and treatment period for aromatase inhibitors in breast cancer have expanded, but information regarding adverse cardiovascular disease events from long-term use remains lacking.
Does aromatase inhibitor treatment increase the risk of cardiovascular events and worsen lipid profiles in adult female breast cancer patients compared to tamoxifen?
Meta-Analysis
Yes
Does aromatase inhibitor treatment increase the risk of cardiovascular events and worsen lipid profiles in adult female breast cancer patients compared to tamoxifen?
Aromatase inhibitors increase the risk of ischemic stroke and worsen lipid profiles compared to tamoxifen, highlighting the need for individualized cardiovascular risk assessment in breast cancer survivors.
Aromatase inhibitors may increase ischemic stroke risk versus tamoxifen; this meta-analysis leaves open whether findings warrant tailored cardiovascular monitoring in breast cancer patients.
Cardiovascular disease (CVD) is one of the most common comorbidities in breast cancer survivors. Recently, the target population and treatment period for aromatase inhibitor (AI) treatment in breast cancer patients has been expanding. However, information on adverse CVD events from the long-term use of AI is still lacking. The aim of this study was to investigate the CVD side effects of AI treatment and to evaluate the changes in lipid profile during AI treatment. A systematic search of PubMed (Medline), EMBASE, and Cochrane Library databases reporting on cardiovascular outcomes or lipid profiles change in adult female breast cancer patients (>19 years old) with AI was performed. The pooled analysis of 25 studies showed that the prevalence rate of any type of cardiovascular disease was 6.08 per 100 persons (95% CI 2.91-10.31). Angina was the most common type of heart-related cardiovascular event accounting for 3.85 per 100 persons, followed by any type of stroke (3.34) and venous thromboembolism (2.95). Ischemic stroke (OR 1.39, 95% CI 1.07-1.81) and myocardial infarction (OR 1.30, 95% CI 0.88-1.93) were more common in AI compared with tamoxifen, whereas the prevalence of venous thromboembolism (OR 0.61, 95% CI 0.37-1) was significantly lower in the AI group. In addition, treatment with AI for 6-12 months showed a decrease in HDL-cholesterol and an increase in LDL-cholesterol and total cholesterol. Various CVDs can occur when using AI, and in particular, the risk of MI and ischemic stroke increases in comparison with the adverse effect of tamoxifen. The occurrence of CVD might be related to the deterioration of the lipid profile after AI treatment. Therefore, a customized individualization strategy considering each patient's CV risk factors is needed during AI treatment.
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Yoo et al. (2023) conducted a meta-analysis in Breast cancer. Aromatase inhibitors vs. Tamoxifen was evaluated on Prevalence of any type of cardiovascular disease (95% CI 2.91-10.31). Aromatase inhibitor use was associated with an overall cardiovascular event prevalence of 6.08%, with a significantly increased risk of ischemic stroke (OR 1.39) compared to tamoxifen.
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