Simon T, Boutouyrie P, Simon J M, Laloux B, Tournigand C, Tropeano A I, Laurent S, Jaillon P
Department of Pharmacology, St Antoine University-Hospital, Paris, France.
Circulation. 2002 Dec 3;106(23):2925-9. doi: 10.1161/01.cir.0000041044.93571.ca.
Intima-media thickness of the common carotid artery (IMT-CCA) is an early marker of atherosclerosis. Tamoxifen is a selective estrogen-receptor modulator with estrogen-like effects on cardiovascular risk factors but as-yet unexplored effects on carotid artery structure. The goal of this study was to determine the influence of tamoxifen on IMT-CCA in menopausal women.
With a predefined calculation of the sample size, 67 menopausal women with cancer who were treated with tamoxifen for > or =1 year and 37 menopausal women with cancer who were never treated with tamoxifen were enrolled. IMT-CCA, internal diameter, and pulse pressure were determined with a high-definition echotracking device and applanation tonometry in a central core laboratory that was blinded to treatment. Both groups were similar for clinical characteristics, including cardiovascular risk factors. IMT and internal diameter were significantly lower in the tamoxifen group (mean duration of treatment, 2.4+/-0.9 years) than in the control group (609+/-117 microm versus 662+/-147 microm, P=0.04, and 4.89+/-0.60 mm versus 5.12+/-0.58 mm, P=0.03, respectively). Pulse pressure was not influenced by the use of tamoxifen. After adjustment for age, cardiovascular risk factors, carotid pulse pressure, duration of menopause, and previous use of hormone replacement therapy, IMT remained significantly lower among tamoxifen users (P<0.00001), with an impact on IMT (-70 microm) equivalent to spontaneous evolution with 12 years of aging (5 microm/y).
The use of tamoxifen was associated with a significantly lower carotid IMT in menopausal women with cancer. Randomized trials are needed to confirm the cardioprotective effect of selective estrogen-receptor modulators in terms of prevention of atherosclerosis.
颈总动脉内膜中层厚度（IMT-CCA）是动脉粥样硬化的早期标志物。他莫昔芬是一种选择性雌激素受体调节剂，对心血管危险因素具有类雌激素作用，但对颈动脉结构的影响尚未得到研究。本研究的目的是确定他莫昔芬对绝经后女性IMT-CCA的影响。
通过预先确定的样本量计算方法，纳入了67例接受他莫昔芬治疗≥1年的绝经后癌症女性患者以及37例从未接受过他莫昔芬治疗的绝经后癌症女性患者。在一个对治疗情况不知情的中心核心实验室中，使用高清回声跟踪设备和压平眼压计测定IMT-CCA、内径和脉压。两组在临床特征方面相似，包括心血管危险因素。他莫昔芬组（平均治疗时间为2.4±0.9年）的IMT和内径显著低于对照组（分别为609±117微米对662±147微米，P=0.04；4.89±0.60毫米对5.12±0.58毫米，P=0.03）。脉压不受他莫昔芬使用的影响。在对年龄、心血管危险因素、颈动脉脉压、绝经持续时间和既往激素替代疗法使用情况进行调整后，他莫昔芬使用者的IMT仍然显著较低（P<0.00001），对IMT的影响（-70微米）相当于12年自然衰老（5微米/年）的影响。
在患有癌症的绝经后女性中，使用他莫昔芬与显著降低的颈动脉IMT相关。需要进行随机试验来证实选择性雌激素受体调节剂在预防动脉粥样硬化方面的心脏保护作用。
