Effects of Raloxifene on Cardiovascular Events and Breast Cancer in Postmenopausal Women

Barrett‐Connor, Elizabeth; Mosca, Lori; Collins, Peter; Geiger, Margarethe; Grady, Deborah; Kornitzer, Marcel; McNabb, Michelle; Wenger, Nanette K.

doi:10.1056/nejmoa062462

Cited by 945 publications

(539 citation statements)

References 29 publications

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“…Along with increased risk of fatal stroke and venous thromboembolic disease in postmenopausal women there is also an increase in thrombotic and thromboembolic events. However, SERMs should not be prescribed or used in bedridden patients who are at risk for thromboembolism (Grady et al, 2000;Barrett-Connor et al, 2006).…”

Section: Estrogen Agonistsmentioning

confidence: 99%

Marine Natural Products: New Avenue in Treatment of Osteoporosis

Chaugule¹,

Indap²,

Chiplunkar

2017

Front. Mar. Sci.

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Bone metabolism is a physiological process that maintains the skeletal integrity and bone functions. Skeletal integrity is always balanced by two key cell types-bone resorbing osteoclasts and bone-forming osteoblasts. Imbalance between generation and function of osteoclasts and osteoblasts often leads to pathological conditions such as osteoporosis, osteopetrosis, Paget's disease. Osteoporosis is one of the most common age-related diseases characterized by decreased bone mineral density and microarchitectural deterioration. Current therapies are indeed effective in preventing bone loss but are also followed by side effects. Since many years, marine organisms have been considered as a good source of bioactive molecules or compounds with potential pharmaceutical properties. Marine Natural Products (MNPs) derived from various marine resources such as marine cyanobacteria, dinoflagellates, algae, sponges, soft corals, molluscs, fishes, and mangroves had shown profound effect on bone metabolism through inhibiting osteoclastogenesis and up-regulating osteoblastogenesis via modulating RANK/RANKL/OPG pathway. Amongst the pre-clinically investigated MNPs for management of osteoporosis, very few are under phase I clinical trials. This review discusses the currently available pharmacological drugs and there major health concern in osteoporosis treatment. It further gives an insight into various marine resources and marine-derived bioactive products, depicting their mechanism of action, functional role, and how these can be exploited for the treatment of osteoporosis.

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Section: Estrogen Agonistsmentioning

confidence: 99%

Marine Natural Products: New Avenue in Treatment of Osteoporosis

Chaugule¹,

Indap²,

Chiplunkar

2017

Front. Mar. Sci.

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“…In fact, epidemiological data suggest a dose-response relationship between the serum level of endogenous sex hormones and the risk of breast cancer [9,19,20]. In addition, some of the therapies for breast cancer target estrogen receptors, further strengthening the causal links between estrogen and breast cancer [21].…”

mentioning

confidence: 99%

Current breast cancer risks of hormone replacement therapy in postmenopausal women

Shah

Wong²

2006

Expert Opinion on Pharmacotherapy

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The controversies surrounding hormone replacement therapy have left many women confused and afraid. Providers have been faced with long-standing assumptions challenged by an abundance of new data in the past few years, with little guidance on how to interpret these findings. The objective of this paper is to provide a framework for understanding breast cancer risk associated with postmenopausal hormone replacement therapy, with a particular focus on how observational studies and randomised trials provide complementary information. This framework considers the data on risks of various hormonal preparations, the profiles of women at risk, and ends with an expert opinion in this context.

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“…19 In the Multiple Outcomes of Raloxifene Evaluation (MORE), 13 Continuing Outcomes Relevant to Evista (CORE), 14 and Raloxifene Use for The Heart (RUTH) 15 trials, a somewhat greater raloxifene effect in reducing breast cancers was seen compared with the tamoxifen effects in placebo trials. However, in the STAR trial, directly comparing tamoxifen to raloxifene with long -term follow--up, tamoxifen had greater influence on reducing the incidence of invasive breast cancer (HR, 0.81; 95% CI, 0.70-0.93).…”

mentioning

confidence: 99%

“…[5][6][7][8][9][10][11][12] In addition, the SERM, raloxifene, approved as therapy for bone loss in postmenopausal women, has been compared against placebo in 2 randomized trials in women with osteoporosis 13,14 and in 1 trial in women with established or at risk of heart disease. 15 In these trials, while breast cancer risk was not evaluated at entry, breast cancers were recorded. Finally, raloxifene was directly compared with tamoxifen in the National Surgical Adjuvant Breast Project (NSABP) chemoprevention trial in postmenopausal women where breast cancer incidence was the primary study outcome.…”

mentioning

confidence: 99%

Current concepts in breast cancer chemoprevention

Chlebowski¹

2014

Polish Archives of Internal Medicine

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Selective Estrogen Receptor Modulators Breast Cancer Prevention TrialInterest of breast cancer chemoprevention was generated by the finding that the selective estrogen receptor modulator (SERM), tamoxifen, when used as adjuvant therapy of both pre-and postmenopausal women with Introduction Breast cancer is the most common cancer in women. The term "chemoprevention" describes interventions used in women with no prior breast cancer to reduce breast cancer risk. 1 However, given that breast cancers take years to develop and become clinically detectable, can chemoprevention administered for a relatively short time of 3 or 5 years interfere with such a long--term process? Santen et al.2 addressed this issue using a clinically based model, an average 200 -day time of breast cancer doubling, 1.16 cm breast cancer detection threshold for mammography, and a 7% prevalence of subclinical breast cancer in postmenopausal women based on autopsy series. This model was applied to a population from the Women's Health Initiative (WHI) randomized trial evaluating estrogen plus progestin, 3 which involved a population quite similar to that participating in most breast cancer ABSTRACTIn Western countries, breast cancer is the most common cancer in women but available interventions can reduce risk. The aim of the paper was to review the available evidence regarding breast cancer chemoprevention trials. A systematic literature search was conducted to identify all full -scale, randomized prospective chemoprevention trials as well as similarly conducted randomized trials with breast cancer as the primary monitoring endpoint. In full -scale, randomized chemoprevention trials, the selective estrogen receptor modulators (SERMs), tamoxifen and raloxifene, reduce breast cancer incidence. In a direct comparison, tamoxifen resulted in greater breast cancer reduction than raloxifene but with greater endometrial cancer risk. The aromatase inhibitors, exemestane and anastrozole, also reduce breast cancer incidence in breast cancer prevention trials. In the Women's Health Initiative hormone therapy trials, in postmenopausal women with no prior hysterectomy, estrogen plus progestin increased breast cancer incidence and deaths from breast cancer, while estrogen alone, in women with prior hysterectomy, reduced breast cancer incidence and reduced deaths from breast cancer. For premenopausal women at increased breast cancer risk, tamoxifen is a proven option with favorable side effect profile. For postmenopausal women, while no direct comparison of SERMs and aromatase inhibitors for chemoprevention are available, cross -study comparisons suggest greater efficacy and more favorable side effect profile for aromatase inhibitor use, especially for older women. The opposite effects of estrogen plus progestin compared with estrogen alone on breast cancer incidence and outcome should factor into risk -benefit consideration when these agents are considered for climacteric symptom management. 39-3.42; P = 0.001), thromboembolic disease (HR, 1.60; 95% CI, 1.2...

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Effects of Raloxifene on Cardiovascular Events and Breast Cancer in Postmenopausal Women

Cited by 945 publications

References 29 publications

Marine Natural Products: New Avenue in Treatment of Osteoporosis

Marine Natural Products: New Avenue in Treatment of Osteoporosis

Current breast cancer risks of hormone replacement therapy in postmenopausal women

Current concepts in breast cancer chemoprevention

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