Comparison of dyslipidemia incidence in Chinese early-stage breast cancer patients following different endocrine therapies: A population-based cohort study

Abstract

BackgroundThere is lack of large-scale real-world research evidence showing the impact of endocrine therapy on blood lipids in Chinese breast cancer patients, especially those with premenopausal breast cancer. Based on a large breast cancer cohort at West China Hospital, we aimed to compare the risk of dyslipidemia between premenopausal and postmenopausal women based on the endocrine therapy used.MethodsA total of 1,883 early-stage breast cancer (EBC) patients who received endocrine monotherapy [selective estrogen receptor modulator (SERM) and aromatase inhibitor (AI), with or without ovarian function suppression] with normal blood lipid levels at baseline were retrospectively included between October 2008 and April 2017. Dyslipidemia was defined as an abnormality in cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein, and total cholesterol (TC) levels. The risk accumulation function was used to calculate the incidence of dyslipidemia in order to assess the absolute risk, while the multivariate Cox regression model was used to calculate the relative risk of dyslipidemia between the groups.ResultsPatients with EBC were followed up for 60 months to monitor their blood lipid levels. The accumulated 5-year incidence of dyslipidemia in postmenopausal patients was higher than that in premenopausal patients (adjusted HR [95% confidence interval], 1.25 [1.01–1.56], 41.7% vs. 31.2%, p = 0.045). In premenopausal patients, the risk of abnormal TC was significantly higher in the OFS+AI group compared with that in the SERM group (adjusted HR [95% CI], 6.24 [3.19–12.20], p < 0.001, 5-year abnormal rates: 21.5% vs. 2.4%), and that of abnormal LDL-C level also increased (adjusted HR [95% CI], 10.54 [3.86–28.77], p < 0.001, 5-year abnormal rates: 11.1% vs. 0.9%). In postmenopausal patients, the risk of abnormal TC or LDL-C levels showed a similar trend in the AI and SERM groups.ConclusionsIn addition to postmenopausal patients, dyslipidemia is also common in premenopausal Chinese patients with EBC who received endocrine therapy. Irrespective of menopausal status, AI treatment increases the risk of TC/LDL-C dyslipidemia than SERM treatment.

Development of cardiometabolic risk factors following endocrine therapy in women with breast cancer

“…In contrast, prior research frequently reports no signi cant changes in lipid pro les with AI use [19,34,35,41,43,44]. Furthermore, studies investigating dyslipidemia as an outcome endpoint reported no association in BC survivors comparing AI to tamoxifen users [40,43]. Since tamoxifen use is associated with improvements in lipid biomarkers, its cardioprotective effects may mask any possible deleterious impacts of AI use when compared with each other.…”

“…Our nding of no association with dyslipidemia in pre-and postmenopausal tamoxifen users is generally consistent with the existing literature. Studies suggest favorable lipid pro les, including decreased total cholesterol and low-density lipoprotein cholesterol and increased high-density lipoprotein cholesterol, for tamoxifen users in both premenopausal and postmenopausal BC survivors [31][32][33][34][35][36][37][38][39][40][41][42]. In contrast, prior research frequently reports no signi cant changes in lipid pro les with AI use [19,34,35,41,43,44].…”

Lipid changes during endocrine therapy in early-stage breast cancer patients: A real-world study

“…A 100-month follow-up of the ATAC trial revealed a higher incidence of hypercholesterolemia in the ANA group compared to the TAM group among postmenopausal BC patients [ 20 ]. A large cohort study also found that, whether postmenopausal or premenopausal, TC and LDL-C levels in the AI group were higher than in the SERM group [ 21 ]. This difference may be due to the different mechanisms between AIs and SERMs.…”

“…Research has indicated that using OFS at a younger age may exacerbate lipid-related events in premenopausal patients [ 26 ]. However, a 5-year cohort study revealed a higher incidence of dyslipidemia in postmenopausal patients compared to their premenopausal counterparts (42.6% vs. 32.6%) [ 21 ]. This study also showed a higher incidence of dyslipidemia in postmenopausal patients, especially in the first year after medication, then the difference disappeared.…”