Recent research indicates that prolonged treatment with aromatase inhibitors, used for estrogen suppression in hormone receptor-positive postmenopausal breast cancer patients, is safe and does not increase the risk of coronary artery calcification. This finding contradicts earlier studies suggesting potential cardiovascular risks associated with such treatments. The study’s results are published in the Canadian Journal of Cardiology.
Coronary artery calcification is a key predictor of adverse cardiovascular outcomes and is linked to atherosclerosis, which can lead to angina and heart attacks. Although estrogen is known to benefit cardiovascular health, its suppression is often essential for breast cancer treatment. Aromatase inhibitors are a standard post-surgical therapy for postmenopausal women with breast cancer, effective in reducing recurrence risks. However, concerns have emerged regarding their potential cardiovascular side effects.
Lead investigator Dr. Yu Hiasa of Ehime University Graduate School of Medicine stated, “Our data suggest that longer use of aromatase inhibitors, typically employed to prevent late recurrences of breast cancer, is safe regarding coronary artery calcification.”
The study involved 357 postmenopausal breast cancer patients who began adjuvant endocrine therapy with aromatase inhibitors between August 2010 and October 2022. Researchers used a visual ordinal scoring system to quantify coronary artery calcification and assessed various patient characteristics. They employed a multivariable logistic regression model to identify independent risk factors for elevated calcification scores.
Co-investigator Dr. Akinori Higaki noted that neither the duration of aromatase inhibitor treatment nor the presence of osteoporosis was linked to coronary artery calcification severity. Furthermore, in patients who had pre-existing coronary artery calcification, treatment did not exacerbate the condition.
Beyond known risk factors like age, hypertension, and diabetes, the study found that low hemoglobin levels also independently correlated with coronary artery calcification.
In an accompanying editorial, Dr. Ibrahim Alfaris from Stanford University highlighted the significance of identifying low hemoglobin as a potential cardiovascular risk factor in this patient population. He suggested that this could lead to changes in screening practices, as anemia is often overlooked in traditional cardiovascular risk assessments.
Dr. Alfaris emphasized the importance of understanding the relationship between extended aromatase inhibitor therapy and coronary artery calcification, as it has implications for the long-term health management of breast cancer survivors, who face increased cardiovascular risks due to their treatment.
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