Abdel-Qadir Husam, Amir Eitan, Fischer Hadas D, Fu Longdi, Austin Peter C, Harvey Paula J, Rochon Paula A, Lee Douglas S, Anderson Geoffrey M
Department of Medicine, University of Toronto, Suite RFE 3-805, 200 Elizabeth Street, M5G 2C4, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, G1 06, 2075 Bayview Ave, M4N 3M5, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Suite 425, M5T 3M6, Toronto, Ontario, Canada; Women's College Hospital, 76 Grenville Street, M5S1B2, Toronto, Ontario, Canada.
Department of Medicine, University of Toronto, Suite RFE 3-805, 200 Elizabeth Street, M5G 2C4, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Suite 425, M5T 3M6, Toronto, Ontario, Canada; Princess Margaret Cancer Centre, 610 University Ave, M5G 2M9, Toronto, Ontario, Canada.
Eur J Cancer. 2016 Nov;68:11-21. doi: 10.1016/j.ejca.2016.08.022. Epub 2016 Sep 30.
Aromatase inhibitors (AIs) may increase cardiovascular risk relative to tamoxifen in post-menopausal women with breast cancer. This risk has not been well-quantified outside of clinical trials.
Observational population-based cohort study of women aged >55 years diagnosed with stage I-III breast cancer between 2005 and 2010. Women treated with AIs or tamoxifen were followed to March 2012. The primary outcome was hospitalisation for myocardial infarction (MI). Cause-specific hazards were compared using tamoxifen as the reference group. Inverse probability of treatment weighting using the propensity score was used to reduce confounding due to measured baseline covariates. Results were confirmed using two cause-specific hazards models. Subgroup analyses included women aged ≥66 years, those with prior ischaemic heart disease, and a 'lower-risk group' aged <74 years with stage I-II cancer and no prior ischaemic heart disease.
In 7409 aromatase inhibitor-treated and 1941 tamoxifen-treated women, the median age was 71 versus 74 years, respectively (p < 0.001). Baseline prevalence of ischaemic heart disease was similar (17.0% versus 16.9%, p = 0.96). Over a mean of 1184 d of follow-up, there were 123 hospitalisations for MI; the cause-specific hazard was higher with AIs (hazard ratio 2.02; 95% confidence interval 1.16-3.53 in the weighted sample). We observed comparable patterns within pre-defined subgroups and when adjusted using cause-specific hazards models.
Aromatase inhibitors are associated with a higher risk of MI compared with tamoxifen. This risk should be accounted for when managing aromatase inhibitor-treated women.
对于绝经后乳腺癌女性，与他莫昔芬相比，芳香化酶抑制剂（AIs）可能会增加心血管疾病风险。在临床试验之外，这种风险尚未得到充分量化。
对2005年至2010年间诊断为I - III期乳腺癌的55岁以上女性进行基于人群的观察性队列研究。接受AIs或他莫昔芬治疗的女性随访至2012年3月。主要结局是因心肌梗死（MI）住院。以他莫昔芬作为参照组比较特定病因风险。使用倾向评分进行治疗权重逆概率分析，以减少因测量的基线协变量导致的混杂。使用两个特定病因风险模型对结果进行验证。亚组分析包括年龄≥66岁的女性、有既往缺血性心脏病的女性，以及年龄<74岁、患有I - II期癌症且无既往缺血性心脏病的“低风险组”。
在7409例接受芳香化酶抑制剂治疗的女性和1941例接受他莫昔芬治疗的女性中，中位年龄分别为71岁和74岁（p < 0.001）。缺血性心脏病的基线患病率相似（17.0%对16.9%，p = 0.96）。在平均1184天的随访期间，有123例因MI住院；在加权样本中，AIs的特定病因风险更高（风险比2.02；95%置信区间1.16 - 3.53）。在预定义亚组中以及使用特定病因风险模型进行调整时，我们观察到了类似的模式。
与他莫昔芬相比，芳香化酶抑制剂与更高的MI风险相关。在管理接受芳香化酶抑制剂治疗的女性时应考虑到这种风险。
