Tamoxifen, serum lipoproteins and cardiovascular risk

Abstract

Summary The influence of tamoxifen on plasma lipids and lipoproteins was monitored in 46 postmenopausal and 8 premenopausal women treated for advanced breast cancer up till 6 months. Total cholesterol (total-C) did not significantly change. However, high density lipoprotein cholesterol (HDL-C) and the HDL-C/ total-C ratio rose significantly. Low density lipoprotein cholesterol was significantly decreased. Triglycerides and free fatty acids did not change markedly. The concomitant rise of sex hormone binding globulin and thyroxine binding globulin indicates that the increase of HDL-C with prolonged use of tamoxifen is compatible with an intrinsic oestrogenic effect of tamoxifen on the liver. The increased HDL-C/total-C ratio lends no support to the concern that long-term administration of this anti-oestrogenic drug might lead to an increased cardiovascular risk.

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

“…In 1988, Bruning et al revealed the LDL-lowering and HDL-increasing properties of tamoxifen. 6 In 1991, Love et al further elucidated tamoxifen's favorable effects on lipid and lipoprotein profiles, from which a mean decrease of 12% in total cholesterol and a mean decrease of 20% in calculated LDL-C levels were detected at the end of a 24-month follow-up, even though plasma glucose levels, reported exercise and work activity, weight, and systolic and diastolic blood pressures did not change with tamoxifen treatment. 7 In the late 1990 s, Joseph et al demonstrated that tamoxifen treatment among breast cancer patients reduced coronary artery disease alongside a reduction of the risk of heart-related death for 0.32/1,000 patients in the B-14 study.…”

Cardiovascular Effects of Droloxifene, a New Selective Estrogen Receptor Modulator, in Healthy Postmenopausal Women

“…Other benzothiophene derivatives, such as raloxifene, and other structurally unrelated compounds, such as soy phytoestrogens and tibolone, have variable degrees of estrogen agonistic and antagonistic effects. 5 Tamoxifen lowers cholesterol, 6 and in trials in women with breast cancer, it was associated with 15% to 63% fewer cardiovascular events. 7 However, tamoxifen also increases the risk for endometrial hyperplasia/carcinoma 8 and is therefore not an ideal cardioprotective agent.…”

Development of an Integrated Program of Health Related Quality of Life Research for the National Surgical Adjuvant Breast and Bowel Project (NSABP)

“…The P-1 study evolved from a series of studies demonstrating the efficacy of tamoxifen in the prevention of breast cancer systemic recurrence (1)(2)(3)(4) and the reduction of contralateral breast cancers in women with early stage breast cancer (1,3,5,6). Other studies demonstrated the benefits of tamoxifen in the lowering of serum cholesterol and increasing bone mineral density in postmenopausal women with breast cancer (7)(8)(9)(10)(11)(12) and in the reduction in cardiac events in women with early-stage breast cancer (13). The P-1 study was a randomized, placebo controlled trial.…”

“…The first analyses include the time period in which at le^t some patients were on therapy (weeks [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20], to compare the experience of patients during a comparable time frame. This would potentially allow any improvements in quality of hfe after the completion of AC to balance more severe quality of life decrements during AC treatment.…”

“…Previously, two double-blind, placebocontrolled studies of the effects of tamoxifen in postmenopausal women (7,8) found no association of tamoxifen with depression. We believe that some of the concern over the relationship between tamoxifen and depression arises fi-om the idea that, because hormone replacement therapy has positive effects on mood and tamoxifen has antiestrogenic activity (9)(10)(11), tamoxifen, therefore, has negative effects on mood.…”