Association of Tamoxifen Use and Reduced Cardiovascular Events Among Asian Females With Breast Cancer

Yang, Tsung‐Lin; Wu, Tao Cheng; Huang, Chin Chou; Huang, Po Hsun; Chung, Chia Min; Lin, Shing Jong; Chen, Jaw Wen; Chan, Wan Leong; Chiang, Chi‐Lu; Leu, Hsin Bang

doi:10.1253/circj.cj-13-0266

Cited by 19 publications

(15 citation statements)

References 24 publications

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“…That is, the higher the average daily dose of tamoxifen use, the greater the risk of ischemic cerebrovascular disease. Our findings are compatible with previous studies showing that tamoxifen use was significantly associated with increased odds of ischemic cerebrovascular disease (adjusted OR 1.82–1.88), (Bushnell and Goldstein, 2004 ; Hooning et al, 2006 ) but contrary to Yang et al's study showing that tamoxifen use was significantly associated with reduced hazard of ischemic cerebrovascular disease (adjusted HR 0.52, 95% CI 0.35, 0.78) (Yang et al, 2014 ). In Yang et al's study, the index date seems to be the date of a subject being diagnosed with breast cancer, rather than the date of tamoxifen being prescribed.…”

Section: Discussionsupporting

confidence: 89%

“…Some animal studies showed that tamoxifen use has a neuroprotective effect in cerebral ischemia (Kimelberg et al, 2000 ; Mehta et al, 2003 ; Zhang et al, 2007 ; Wakade et al, 2008 ; Boulos et al, 2011 ). Epidemiological studies showed inconsistent results about tamoxifen use on the risk of ischemic cerebrovascular disease, including reduced risk, (Yang et al, 2014 ) increased risk, (Bushnell and Goldstein, 2004 ; Hooning et al, 2006 ) and no association (Geiger et al, 2004 ).…”

Section: Introductionmentioning

confidence: 99%

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Tamoxifen Use Correlates with Increased Risk of the First Episode of Ischemic Cerebrovascular Disease in Older Women with Breast Cancer: A Case-Control Study in Taiwan

2017

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Background and Objectives: There are inconsistent results about the association between ischemic cerebrovascular disease and tamoxifen use in women with breast cancer. The study aimed to evaluate the association between the risk of ischemic cerebrovascular disease and tamoxifen use in older women with breast cancer in Taiwan.Methods: We designed a retrospective, nationwide, case-control study using the database of the Taiwan National Health Insurance Program. A total of 800 female subjects with breast cancer aged ≥65 years with the first episode of ischemic cerebrovascular disease from 2000 to 2011 were identified as the cases. Additionally, 2,876 female subjects with breast cancer aged ≥65 years without any type of cerebrovascular diseases were selected as the control subjects. The cases and the control subjects were matched with age and comorbidities. Ever use of tamoxifen was defined as a subject who had at least a prescription for tamoxifen before the index date. Never use of tamoxifen was defined as a subject who never had a prescription for tamoxifen before the index date. We used the multivariable logistic regression model to calculate the odds ratio (OR) and 95% confidence interval (CI) for ischemic cerebrovascular disease associated with tamoxifen use.Results: After adjusting for confounding variables, the adjusted OR of ischemic cerebrovascular disease was 2.5 for subjects with ever use of tamoxifen (95% CI 2.10, 2.97), compared with never use of tamoxifen. In addition, the adjusted OR of ischemic cerebrovascular disease was 1.15 (95% CI 1.10, 1.21) in subjects with ever use of tamoxifen as increase in use duration per 1 year. The adjusted OR of ischemic cerebrovascular disease was 2.54 (95% CI 2.03, 3.17) in subjects with ever use of tamoxifen as increase in dosage per 1 mg.Conclusions: Tamoxifen use is significantly associated with 2.5-fold increased odds of ischemic cerebrovascular disease among older women with breast cancer in Taiwan. There are duration-dependent and dose-dependent effects of tamoxifen use on the risk of ischemic cerebrovascular disease.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Tamoxifen Use Correlates with Increased Risk of the First Episode of Ischemic Cerebrovascular Disease in Older Women with Breast Cancer: A Case-Control Study in Taiwan

2017

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“…We included 26 studies after applying the inclusion and exclusion criteria. 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 Six previous meta-analyses or systematic reviews of randomised trials were also identified. 2 5 6 7 8 9 We identified 12 individual randomised controlled trials that met the inclusion criteria from within these meta-analyses and included them in our review.…”

Section: Resultsmentioning

confidence: 99%

Long term adjuvant endocrine therapy and risk of cardiovascular disease in female breast cancer survivors: systematic review

Matthews

Stanway

Farmer

et al. 2018

BMJ

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ObjectiveTo investigate the effect of endocrine therapies on a wide range of specific clinical cardiovascular disease outcomes in women with a history of non-metastatic breast cancer.DesignSystematic review and meta-analysis of randomised controlled trials and observational studies.Data sourcesMedline and Embase up until June 2018.Eligibility criteria for selecting studiesStudies were included if they investigated the risk of a specific cardiovascular disease outcome associated with use of either tamoxifen or an aromatase inhibitor, or compared the two treatments, in women with a history of non-metastatic breast cancer.Appraisal and data extractionRelevant studies were originally identified and results extracted by one researcher, with a full replication of the study identification process by a combination of two other researchers. The Cochrane Collaboration’s tool for assessing risk of bias was used to assess risk of bias in randomised controlled trials, and this tool was adapted to assess risk of bias in observational studies.Results26 studies were identified, with results for seven specific cardiovascular disease outcomes (venous thromboembolism, myocardial infarction, stroke, angina, heart failure, arrhythmia, and peripheral vascular disease). Results suggested an increased risk of venous thromboembolism in tamoxifen users compared with both non-users and aromatase inhibitor users. Results were also consistent with a higher risk of the vascular diseases myocardial infarction and angina in aromatase inhibitor users compared with tamoxifen users, but there was also a suggestion that this may be partly driven by a protective effect of tamoxifen on these outcomes. Data were limited, and evidence was generally inconsistent for all other cardiovascular disease outcomes.ConclusionThis review has collated substantial randomised controlled trial and observational evidence on the effect of endocrine therapies on several specific cardiovascular disease outcomes including venous thromboembolism and myocardial infarction, progressing knowledge. Although the choice of aromatase inhibitor or tamoxifen will primarily be based on the effectiveness against the recurrence of breast cancer, this review shows that the individual patient’s risk of venous or arterial vascular disease should be an important secondary consideration.Systematic review registrationProspero CRD42017065944.

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“…Long-term CS use accelerates the atherosclerotic process and increases the risk of cardiovascular morbidity and death [ 28 ]. Conversely, TMX may have cardioprotective effects [ 29 , 30 ]. This may be particularly relevant when choosing the treatment regimen in patients with multiple cardiovascular risk factors (e.g.…”

Section: Discussionmentioning

confidence: 99%

Outcome in patients with idiopathic retroperitoneal fibrosis treated with corticosteroid or tamoxifen monotherapy

et al. 2016

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BackgroundAlthough corticosteroids (CS) are used primarily in idiopathic retroperitoneal fibrosis (iRPF), tamoxifen (TMX) may be a suitable alternative. We compared outcome with CS or TMX monotherapy for first presentation in a large group of patients with iRPF disease.MethodsOf all patients with iRPF disease who were seen at our tertiary care referral centre from February 1999 to December 2011, 118 patients were eligible for this retrospective study. Treatment success was defined as the composite of (i) amelioration of symptoms, (ii) computed tomography (CT)-documented mass regression and, if applicable, (iii) definitive removal of ureteral stent or nephrostomy tube. Recurrence was defined as recurrence of signs and symptoms and/or CT-documented mass increase after initial treatment success with primary treatment.ResultsPresenting signs and symptoms did not differ between patients treated with CS (n = 50) or TMX (n = 68). Time to amelioration of symptoms after treatment initiation was shorter in CS-treated patients [CS, 2.0 (0.8–3.8) weeks versus TMX, 4.0 (2.0–6.0) weeks; P < 0.01]. Short-term percentual decrease in acute-phase reactant levels (P < 0.001 for both erythrocyte sedimentation rate and C-reactive protein) and serum creatinine level (P < 0.01) following treatment initiation was greater in CS-treated patients compared with that in TMX-treated patients. Mass regression at first follow-up CT scan was observed more frequently in CS-treated patients (CS, 84.0% versus TMX, 68.3%; P = 0.05) with no difference in time interval from treatment initiation to first follow-up CT between groups [CS, 5 (2–7) months versus TMX, 4 (4–5) months; P = 0.34]. Definite treatment success was non-significantly higher in CS-treated patients (CS, 72.7% versus TMX, 58.3%; P = 0.15). In patients with initial treatment success with primary treatment, recurrence rate was lower in TMX-treated patients (CS, 62.5% versus TMX, 21.4%; P < 0.01).ConclusionsCS are superior to TMX in treating iRPF disease. However, in patients with initial treatment success with primary treatment, recurrence rate was lower in TMX-treated patients.

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Association of Tamoxifen Use and Reduced Cardiovascular Events Among Asian Females With Breast Cancer

Cited by 19 publications

References 24 publications

Tamoxifen Use Correlates with Increased Risk of the First Episode of Ischemic Cerebrovascular Disease in Older Women with Breast Cancer: A Case-Control Study in Taiwan

Tamoxifen Use Correlates with Increased Risk of the First Episode of Ischemic Cerebrovascular Disease in Older Women with Breast Cancer: A Case-Control Study in Taiwan

Long term adjuvant endocrine therapy and risk of cardiovascular disease in female breast cancer survivors: systematic review

Outcome in patients with idiopathic retroperitoneal fibrosis treated with corticosteroid or tamoxifen monotherapy

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