No CVD Issues Apparent Years After Aromatase Inhibitor Therapy

The study covered in this summary was published as a preprint and has not yet been peer reviewed.

Key Takeaway

Researchers found no association between aromatase inhibitor exposure and early cardiovascular damage in young breast cancer survivors more than a decade after their diagnosis.

Why This Matters

Aromatase inhibitors are an important component of the adjuvant treatment of hormone receptor-positive breast cancer, but the cardiovascular safety of these drugs has remained unclear.
The results are "reassuring," the investigators say, given the "substantial" oncological benefits of aromatase inhibitors.

Study Design

The researchers assessed 569 breast cancer survivors for three early markers of cardiovascular disease: carotid intima media thickness (cIMT), advanced glycation end products in the skin (AGEs), and dyslipidemia.
For 277 women, 5 to 7 years had passed since their breast cancer diagnosis, and for the remaining 292, 10 to 12 years had passed.
The women were mainly pre-/perimenopausal at the time of their diagnosis and a median of 55.5 years old at study entry.
To quantify aromatase inhibitor exposure, researchers divided the duration of aromatase inhibitor use by the total duration of endocrine therapy.
The authors then classified patients into aromatase inhibitor exposure groups: low (no endocrine therapy or aromatase inhibitor ratio < 0.40), intermediate (aromatase inhibitor ratio 0.40-0.60), or high (aromatase inhibitor ratio > 0.60).

Key Results

Overall, 40% of the study population had taken aromatase inhibitors, most of whom had received tamoxifen. The median duration of therapy was 3 years.
Mean cIMT and AGEs did not differ across low-to-high aromatase inhibitor exposure groups in univariable and multivariable analyses.
The occurrence of dyslipidemia did not vary across aromatase inhibitor exposure groups.
Intermediate aromatase inhibitor exposure was associated with a twofold higher risk of the combined endpoint — elevated cIMT, AGEs, and dyslipidemia — compared with no or low aromatase inhibitor exposure.
However, this association was not observed in the group with the highest aromatase inhibitor exposure.

Limitations

Women who developed severe cardiovascular disease may have died prior to the study.
Duration of follow-up may have been too short for vascular abnormalities to develop in a relatively young and healthy population.
The findings need to be validated in patients with breast cancer at higher risk for cardiovascular disease.

Disclosures

The work was funded by the Dutch Cancer Society.
One investigator is a consultant for Biovica and Seagen, and several disclosed receiving research support from AbbVie and AstraZeneca, among other companies.

This is a summary of a preprint research study, "Adjuvant aromatase inhibitor therapy and early markers for cardiovascular disease in breast cancer survivors," led by Annemiek Van Ommen-Nijhof of the Antoni van Leeuwenhoek Netherlands Cancer Institute. The study has not been peer reviewed. The full text can be found at researchsquare.com.

M. Alexander Otto is a physician assistant with a master's degree in medical science and a journalism degree from Newhouse. He is an award-winning medical journalist who worked for several major news outlets before joining Medscape and is also an MIT Knight Science Journalism fellow. Email: aotto@mdedge.com

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