Franchi Matteo, Tritto Roberta, Tarantini Luigi, Navazio Alessandro, Corrao Giovanni
National Centre for Healthcare Research and Pharmacoepidemiology, 20126 Milan, Italy.
Laboratory of Healthcare Research & Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy.
Cancers (Basel). 2021 May 8;13(9):2254. doi: 10.3390/cancers13092254.
Whether aromatase inhibitors (AIs) increase the risk of cardiovascular (CV) events, compared to tamoxifen, in women with breast cancer is still debated. We evaluated the association between AI and CV outcomes in a large population-based cohort of breast cancer women.
By using healthcare utilization databases of Lombardy (Italy), we identified women ≥50 years, with new diagnosis of breast cancer between 2009 and 2015, who started adjuvant therapy with either AI or tamoxifen. We estimated the association between exposure to AI and CV outcomes (including myocardial infarction, ischemic stroke, heart failure or any CV event) by a Cox proportional hazard model with inverse probability of treatment and censoring weighting.
The study cohort included 26,009 women starting treatment with AI and 7937 with tamoxifen. Over a median follow-up of 5.8 years, a positive association was found between AI and heart failure (Hazard Ratio = 1.20, 95% CI: 1.02 to 1.42) and any CV event (1.14, 1.00 to 1.29). The CV risk increased in women with previous CV risk factors, including hypertension, diabetes and dyslipidemia.
Adjuvant therapy with AI in breast cancer women aged more than 50 years is associated with increased risk of heart failure and combined CV events.
与他莫昔芬相比，芳香化酶抑制剂（AI）是否会增加乳腺癌女性发生心血管（CV）事件的风险仍存在争议。我们在一个基于人群的大型乳腺癌女性队列中评估了AI与CV结局之间的关联。
通过使用伦巴第（意大利）的医疗保健利用数据库，我们确定了年龄≥50岁、在2009年至2015年间新诊断为乳腺癌且开始接受AI或他莫昔芬辅助治疗的女性。我们通过具有治疗逆概率和删失加权的Cox比例风险模型估计了AI暴露与CV结局（包括心肌梗死、缺血性中风、心力衰竭或任何CV事件）之间的关联。
研究队列包括26,009名开始接受AI治疗的女性和7937名接受他莫昔芬治疗的女性。在中位随访5.8年期间，发现AI与心力衰竭（风险比=1.20，95%CI：1.02至1.42）和任何CV事件（1.14，1.00至1.29）之间存在正相关。在有既往CV危险因素（包括高血压、糖尿病和血脂异常）的女性中，CV风险增加。
50岁以上乳腺癌女性接受AI辅助治疗与心力衰竭风险增加和合并CV事件有关。
