The Risk of Cardiovascular Disease following Aromatase Inhibitor Therapy for Breast Cancer in Postmenopausal Women: A Systematic Review and Meta-Analysis.

BACKGROUND

More women are recovering and living longer lives due to advancement in breast cancer therapies. Aromatase inhibitors (AIs) are one form of endocrine therapy for breast cancer that may have an impact on the risk of developing cardiovascular diseases later in life. This study investigated whether AI therapy for breast cancer in postmenopausal women increases the risk of developing cardiovascular disease in comparison with tamoxifen therapy or no hormonal therapy.

METHODS

Comparisons were made between tamoxifen and no hormonal therapy using PRISMA guidelines. We searched publicly available databases for studies including postmenopausal women who underwent AI therapy for breast cancer investigating the risk ratio of specific cardiovascular outcomes and cardiovascular death.

RESULTS

There was a significant increase in the risk of ischaemic heart disease (RR 1.59, 95% CI: 1.25-2.02, < 0.05), myocardial infarction (RR 1.50, 95% CI: 1.13-1.99, < 0.05), heart failure (RR 1.63, 95% CI: 1.14-2.32, < 0.05), and other cardiovascular events (RR 1.26, 95% CI: 1.12-1.40, < 0.05) in the AI group when compared to tamoxifen. However, there was a significant decrease in the risk of myocardial infarction (RR 0.77, 95% CI: 0.65-0.90, < 0.05) in the AI group when compared to no hormonal treatment.

CONCLUSION

There is an increased risk of cardiovascular disease for AI therapy in comparison to tamoxifen therapy. However, further research is needed to establish the cardiovascular risk of AIs when compared to no hormonal therapy. Prognosis and survival of patients should be an important consideration in choosing between tamoxifen and AI therapy among patients receiving treatment for breast cancer. Regular monitoring is essential to facilitate personalized approaches aimed at mitigating the risk of cardiovascular toxicity.