Aromatase inhibitor use is a risk factor of carotid plaque presence in endocrine-responsive breast cancer patients

Seo, Dong-Hoan; Cho, Yongin; Lee, Su Jin; Park, Seho; Kim, Kyung Sik; Park, Byeong Woo; Rhee, Yumie

doi:10.3904/kjim.2016.205

Cited by 4 publications

(3 citation statements)

References 44 publications

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“…Gallicchio et al investigated several vascular parameters including cIMT in a small group (n = 112) of breast cancer patients and found no significant changes after 1 year of AI use [26]. An even smaller study (n = 85) also found no difference in median cIMT when comparing BC patients treated with AI (mean duration of use 34 months) to those not receiving endocrine treatment [27]. Carotid plaques, however, were seen more frequently among AI users in this study.…”

Section: Discussionmentioning

confidence: 99%

Adjuvant aromatase inhibitor therapy and early markers for cardiovascular disease in breast cancer survivors

Ommen-Nijhof

Jacobse

Steggink

et al. 2022

Preprint

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PurposeAromatase inhibitors (AIs) are an important component of the adjuvant treatment of hormone receptor positive breast cancer (BC) but concerns regarding their cardiovascular safety remain. In this cross-sectional study nested in a breast cancer cohort, we investigated the association between AI exposure and early markers for cardiovascular disease in BC survivors.MethodsThe study population consisted of 569 women, who were 5-7 years (n=277) or 10-12 years (n=292) after BC diagnosis. All participants underwent carotid ultrasound, skin autofluorescence measurement and laboratory evaluation. To quantify AI exposure, we obtained the AI ratio by dividing the duration of AI use by the total duration of endocrine therapy (ET). Patients were classified according to their AI ratio into low (no ET or AI ratio <0.40), intermediate (0.40≤ AI ratio ≤0.60) or high AI exposure (AI ratio >0.60). The association between AI ratio and carotid intima media thickness (cIMT), advanced glycation end products (AGEs) and the presence of dyslipidemia was assessed using linear and logistic regression.Results Median age at study visit was 55.5 years (range 45.2-63.8). Forty percent (n=231) of the study population had used AIs, of whom the majority sequentially with tamoxifen; median duration of AI use was 3.0 years. Mean cIMT and mean AGEs did not differ across AI exposure groups in univariable and multivariable analysis. The occurrence of dyslipidemia did not vary across AI exposure groups. Intermediate AI exposure was associated with more frequent occurrence of the combined endpoint (elevated cIMT, elevated AGEs and/or dyslipidemia). This association, however, was not present in the group with highest AI exposure.ConclusionAI exposure was not associated with cIMT, AGEs or the presence of dyslipidemia. Our results are reassuring for the cardiovascular safety of patients who receive treatment with AIs to reduce the risk of BC recurrence.Trial registration number (clinicaltrials.gov): NCT02485626, June 30, 2015

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Section: Discussionmentioning

confidence: 99%

Adjuvant aromatase inhibitor therapy and early markers for cardiovascular disease in breast cancer survivors

Ommen-Nijhof

Jacobse

Steggink

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

“…Gallicchio et al investigated several vascular parameters including cIMT in a small group (n = 112) of breast cancer patients and found no signi cant changes after 1 year of AI use [26]. An even smaller study (n = 85) also found no difference in median cIMT when comparing BC patients treated with AI (mean duration of use 34 months) to those not receiving endocrine treatment [27]. Carotid plaques, however, were seen more frequently among AI users in this study.…”

Section: Discussionmentioning

confidence: 99%

Adjuvant aromatase inhibitor therapy and early markers for cardiovascular disease in breast cancer survivors

Ommen-Nijhof

Jacobse

Steggink

et al. 2022

Breast Cancer Res Treat

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PurposeAromatase inhibitors (AIs) are an important component of the adjuvant treatment of hormone receptor positive breast cancer (BC) but concerns regarding their cardiovascular safety remain. In this cross-sectional study nested in a breast cancer cohort, we investigated the association between AI exposure and early markers for cardiovascular disease in BC survivors. MethodsThe study population consisted of 569 women, who were 5-7 years (n=277) or 10-12 years (n=292) after BC diagnosis. All participants underwent carotid ultrasound, skin auto uorescence measurement and laboratory evaluation. To quantify AI exposure, we obtained the AI ratio by dividing the duration of AI use by the total duration of endocrine therapy (ET). Patients were classi ed according to their AI ratio into low (no ET or AI ratio <0.40), intermediate (0.40≤ AI ratio ≤0.60) or high AI exposure (AI ratio >0.60). The association between AI ratio and carotid intima media thickness (cIMT), advanced glycation end products (AGEs) and the presence of dyslipidemia was assessed using linear and logistic regression. ResultsMedian age at study visit was 55.5 years (range 45.2-63.8). Forty percent (n=231) of the study population had used AIs, of whom the majority sequentially with tamoxifen; median duration of AI use was 3.0 years. Mean cIMT and mean AGEs did not differ across AI exposure groups in univariable and multivariable analysis. The occurrence of dyslipidemia did not vary across AI exposure groups. Intermediate AI exposure was associated with more frequent occurrence of the combined endpoint (elevated cIMT, elevated AGEs and/or dyslipidemia). This association, however, was not present in the group with highest AI exposure. ConclusionAI exposure was not associated with cIMT, AGEs or the presence of dyslipidemia. Our results are reassuring for the cardiovascular safety of patients who receive treatment with AIs to reduce the risk of BC recurrence.Trial registration number (clinicaltrials.gov): NCT02485626,

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“…Endocrine therapy was not part of the standard treatment for patients with breast cancer in the Netherlands until the mid-1990s. However, nowadays, patients frequently receive endocrine therapy, and it has been shown that this therapy is associated with the presence of carotid plaques [ 40 ]. Also, the CMF regimen is no longer considered an optimal adjuvant chemotherapy regimen for breast cancer, but it has been the standard regimen worldwide up to the 1990s [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

Long-term effects of adjuvant treatment for breast cancer on carotid plaques and brain perfusion

Koppelmans

Willik

Aleman

et al. 2020

Breast Cancer Res Treat

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Purpose Breast cancer treatment has been associated with vascular pathology. It is unclear if such treatment is also associated with long-term cerebrovascular changes. We studied the association between radiotherapy and chemotherapy with carotid pathology and brain perfusion in breast cancer survivors. Methods We included 173 breast cancer survivors exposed to radiotherapy and chemotherapy, assessed ± 21.2 years after cancer diagnosis, and 346 age-matched cancer-free women (1:2) selected from the population-based Rotterdam Study. Outcome measures were carotid plaque score, intima-media thickness (IMT), total cerebral blood flow (tCBF), and brain perfusion. Additionally, we investigated the association between inclusion of the carotid artery in the radiation field (no/small/large part), tumor location, and these outcome measures within cancer survivors. Results Cancer survivors had lower tCBF (− 19.6 ml/min, 95%CI − 37.3;− 1.9) and brain perfusion (− 2.5 ml/min per 100 ml, 95%CI − 4.3;− 0.7) than cancer-free women. No statistically significant group differences were observed regarding plaque score or IMT. Among cancer survivors, a large versus a small part of the carotid artery in the radiation field was associated with a higher IMT (0.05, 95%CI0.01;0.09). Also, survivors with a right-sided tumor had lower left carotid plaque score (− 0.31, 95%CI − 0.60;− 0.02) and higher brain perfusion (3.5 ml/min per 100 ml, 95%CI 0.7;6.2) than those with a left-sided tumor. Conclusions On average two decades post-diagnosis, breast cancer survivors had lower tCBF and brain perfusion than cancer-free women. Also, survivors with a larger area of the carotid artery within the radiation field had a larger IMT. Future studies should confirm if these cerebrovascular changes underlie the frequently observed cognitive problems in cancer survivors.

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Aromatase inhibitor use is a risk factor of carotid plaque presence in endocrine-responsive breast cancer patients

Cited by 4 publications

References 44 publications

Adjuvant aromatase inhibitor therapy and early markers for cardiovascular disease in breast cancer survivors

Adjuvant aromatase inhibitor therapy and early markers for cardiovascular disease in breast cancer survivors

Adjuvant aromatase inhibitor therapy and early markers for cardiovascular disease in breast cancer survivors

Long-term effects of adjuvant treatment for breast cancer on carotid plaques and brain perfusion

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