Chang Wei-Ting, Chen Po-Wei, Lin Hui-Wen, Kuo Yu-Hsuan, Lin Sheng-Hsiang, Li Yi-Heng
Division of Cardiology, Department of Internal Medicine, Chi-Mei Medical Center, Tainan 710402, Taiwan.
Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan 701401, Taiwan.
Cancers (Basel). 2022 Jan 20;14(3):508. doi: 10.3390/cancers14030508.
Despite a preferred endocrine therapy for women with estrogen and progesterone receptor-positive breast cancer, aromatase inhibitors (AIs) have been reported to increase risks of cardiovascular events. Given that breast cancer patients in Asia are younger at diagnosis, it is urgent to investigate this safety concern.
Through the Taiwanese National Cohort, we identified breast cancer patients initiating selective estrogen receptor modulators (SERMs) or AIs from 2010 to 2016. Outcomes includes major adverse cardio- and cerebrovascular events (MACCEs). The average follow-up duration was five years.
We identified 16,730 breast cancer patients treated with SERMs and 11,728 receiving AIs. The population was older and had more comorbidities in the AI group than in the SERM group. After adjusting for age, cancer stage, cancer therapies, cardiovascular drugs and comorbidities, despite similar risks of MACCEs between AI and SERM users, the risk of HF was significantly higher in patients treated with SERMs after adjusted mortality as a competing risk. When divided by the age of 50 years, despite a similar MACCEs in the younger population, MACCEs remained significantly higher in the older population who received SERMs.
In this Asian cohort, we found that among patients of old age or with advanced cancer stage, the use of SERMs was associated with a higher risk of cardiovascular events than the use of AIs.
尽管雌激素和孕激素受体阳性乳腺癌女性患者有首选的内分泌治疗方法，但据报道，芳香化酶抑制剂（AI）会增加心血管事件风险。鉴于亚洲乳腺癌患者诊断时年龄较轻，迫切需要调查这一安全问题。
通过台湾全国队列，我们确定了2010年至2016年开始使用选择性雌激素受体调节剂（SERM）或AI的乳腺癌患者。结局包括主要的心脑血管不良事件（MACCE）。平均随访时间为五年。
我们确定了16730例接受SERM治疗的乳腺癌患者和11728例接受AI治疗的患者。与SERM组相比，AI组患者年龄更大，合并症更多。在调整年龄、癌症分期、癌症治疗、心血管药物和合并症后，尽管AI使用者和SERM使用者发生MACCE的风险相似，但将死亡率作为竞争风险进行调整后，接受SERM治疗的患者发生心力衰竭的风险显著更高。按50岁划分时，尽管年轻人群中MACCE相似，但接受SERM治疗的老年人群中MACCE仍然显著更高。
在这个亚洲队列中，我们发现，在老年患者或癌症晚期患者中，使用SERM比使用AI发生心血管事件的风险更高。
