Tamoxifen Treatment in Danish Breast Cancer Patients and 5-Year Risk of Arterial Atherosclerotic Events: A Null Association

Abstract

Although the effectiveness of tamoxifen in preventing the recurrence of breast cancer is well established, associations between tamoxifen and the occurrence of atherosclerotic events are not as clear. Breast cancer patients taking tamoxifen have lower serum cholesterol and other lipid levels than those not taking tamoxifen, suggesting that tamoxifen might prevent atherosclerotic events, but the existing studies are conflicting. We examined the relation between tamoxifen and incident hospitalization of angina pectoris, acute myocardial infarction, heart failure, and stroke. The study population of 16,289 women was identified from the Danish Breast Cancer Cooperative Group nationwide clinical database and includes women diagnosed with stage I or II estrogen receptor -positive breast cancer between 1990 and 2004 at ages 45 to 69. Use of a large populationbased sample with complete outcome ascertainment allowed us to calculate precise measures of risks, risk ratios, and adjusted hazard ratios comparing tamoxifen-treated patients with untreated patients. We found strong evidence for null associations for each of the four outcomes of interest during the first year and first 5 years after the start of therapy. These findings are important in risk/benefit analyses as tamoxifen therapy in postmenopausal women is being replaced with aromatase inhibitors. (Cancer Epidemiol Biomarkers Prev 2008;17(9):2509 -11)

Adjuvant Tamoxifen Influences the Lipid Profile in Breast Cancer Patients

“…The released glycerol provides the substrate for gluconeogenesis. Based on these observations, it seems reasonable to consider steroid hormone receptors while discussing tamoxifen, the estrogen receptor, and the lipid profile [3,5,24,25]. Furthermore, a new class of steroid hormone receptors has recently been elucidated: Along with the well-documented intracellular receptors, cell membrane receptors have been shown to exist.…”

“…Of interest, some studies have suggested that adjuvant tamoxifen exhibits different effects on the lipid and liver profiles of cancer patients [5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25]. Researchers sought to determine the appropriate role of adjuvant tamoxifen in breast cancer patients regarding serum total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), aspartate transaminase (AST), and alanine transaminase (ALT) levels.…”

“…Researchers sought to determine the appropriate role of adjuvant tamoxifen in breast cancer patients regarding serum total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), aspartate transaminase (AST), and alanine transaminase (ALT) levels. The large population-based study by Hernandez et al [5] revealed that there were no associations between tamoxifen and the occurrence of atherosclerotic events. These findings are important in risk/benefit analyses as tamoxifen therapy in postmenopausal women is being replaced with aromatase inhibitors.…”

Women Commencing Anastrozole, Letrozole or Tamoxifen for Early Breast Cancer: The Impact of Comorbidity and Demographics on Initial Choice

“…We did not include exemestane as it was restricted to advanced breast cancer [23]. The 18-month follow-up period was chosen based on evidence that endocrine therapy is initiated within this timeframe [21], [24]. Of the 1832 women in our dataset dispensed an endocrine therapy during the study period, sensitivity analysis showed that 96% ( N  = 1763) had been dispensed a therapy within 18 months of diagnosis.…”

Coadministrating Luteolin Minimizes the Side Effects of the Aromatase Inhibitor Letrozole

“…However, it may cause endometrial hyperplasia and elevate the cancer risk at this tissue (Lindahl et al, 2008). Moreover, it also increases the risk of stroke after long-term treatment (Hernandez et al, 2008).…”