Cardiovascular and metabolic effects of ovarian suppression in combination with tamoxifen or an aromatase inhibitor as adjuvant therapy for early oestrogen receptor-positive breast cancer: a systematic review
Introduction Adjuvant endocrine therapy is a key treatment in oestrogen receptor positive early breast cancer (BC). For premenopausal women, ovarian function suppression (OFS) in combination with either tamoxifen or aromatase inhibitor (AI) is utilised in high-risk cases. The resultant suppression o...
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| Format: | Article |
| Language: | English |
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Termedia Publishing House
2024-07-01
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| Series: | Archives of Medical Science |
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| Online Access: | https://www.archivesofmedicalscience.com/Cardiovascular-and-metabolic-effects-of-ovarian-suppression-in-combination-with-tamoxifen,190743,0,2.html |
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| author | Ying X. Gue Dorothy Lau Alena Shantsila Gregory Y.H. Lip Carlo Palmieri |
| author_facet | Ying X. Gue Dorothy Lau Alena Shantsila Gregory Y.H. Lip Carlo Palmieri |
| author_sort | Ying X. Gue |
| collection | DOAJ |
| description | Introduction
Adjuvant endocrine therapy is a key treatment in oestrogen receptor positive early breast cancer (BC). For premenopausal women, ovarian function suppression (OFS) in combination with either tamoxifen or aromatase inhibitor (AI) is utilised in high-risk cases. The resultant suppression of circulating oestradiol from OFS could have adverse cardiovascular and metabolic effects, subsequently increasing the risk of cardiovascular disease.
Material and Methods
A systematic search of online databases was conducted to identify randomised control trials involving OFS which reported cardiovascular and metabolic adverse events. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were estimated using a random-effects model.
Results
Four studies with a total of 7808 participants were included in the analysis. Tamoxifen alone carries a lower risk of hypertension compared with tamoxifen plus OFS (4.81% vs. 7.57%, OR = 0.67; 95% CI: 0.49–0.91; p = 0.01). The tamoxifen alone group showed a lower risk of hyperglycaemia compared to tamoxifen with OFS (0.10% vs. 0.86%, OR = 0.11; 95% CI: 0.02–0.85, p = 0.03).
Conclusions
Our study highlights the potential cardio-metabolic impact of endocrine therapy and OFS on premenopausal women with BC. It also highlights the pressing need for standardisation of routine collection and recording of cardiometabolic history and risk factors as part of baseline assessment and adverse event reporting to better understand the cardiometabolic impact these treatments have on our patients. Further studies, with particular focus on baseline and subsequent development of cardiovascular risk factors, are needed to explore the impact of these drugs on the cardiovascular health of young women with BC. |
| format | Article |
| id | doaj-art-fd84bbee4fc949e3b66d22415fe2e5af |
| institution | Kabale University |
| issn | 1734-1922 1896-9151 |
| language | English |
| publishDate | 2024-07-01 |
| publisher | Termedia Publishing House |
| record_format | Article |
| series | Archives of Medical Science |
| spelling | doaj-art-fd84bbee4fc949e3b66d22415fe2e5af2025-08-20T03:49:32ZengTermedia Publishing HouseArchives of Medical Science1734-19221896-91512024-07-0121257758710.5114/aoms/190743190743Cardiovascular and metabolic effects of ovarian suppression in combination with tamoxifen or an aromatase inhibitor as adjuvant therapy for early oestrogen receptor-positive breast cancer: a systematic reviewYing X. Gue0https://orcid.org/0000-0001-9994-8915Dorothy Lau1Alena Shantsila2https://orcid.org/0000-0002-0594-8576Gregory Y.H. Lip3Carlo Palmieri4Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, United KingdomSchool of Medicine, University of Liverpool, Liverpool, United KingdomLiverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, United KingdomLiverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, United KingdomDepartment of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, United KingdomIntroduction Adjuvant endocrine therapy is a key treatment in oestrogen receptor positive early breast cancer (BC). For premenopausal women, ovarian function suppression (OFS) in combination with either tamoxifen or aromatase inhibitor (AI) is utilised in high-risk cases. The resultant suppression of circulating oestradiol from OFS could have adverse cardiovascular and metabolic effects, subsequently increasing the risk of cardiovascular disease. Material and Methods A systematic search of online databases was conducted to identify randomised control trials involving OFS which reported cardiovascular and metabolic adverse events. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were estimated using a random-effects model. Results Four studies with a total of 7808 participants were included in the analysis. Tamoxifen alone carries a lower risk of hypertension compared with tamoxifen plus OFS (4.81% vs. 7.57%, OR = 0.67; 95% CI: 0.49–0.91; p = 0.01). The tamoxifen alone group showed a lower risk of hyperglycaemia compared to tamoxifen with OFS (0.10% vs. 0.86%, OR = 0.11; 95% CI: 0.02–0.85, p = 0.03). Conclusions Our study highlights the potential cardio-metabolic impact of endocrine therapy and OFS on premenopausal women with BC. It also highlights the pressing need for standardisation of routine collection and recording of cardiometabolic history and risk factors as part of baseline assessment and adverse event reporting to better understand the cardiometabolic impact these treatments have on our patients. Further studies, with particular focus on baseline and subsequent development of cardiovascular risk factors, are needed to explore the impact of these drugs on the cardiovascular health of young women with BC.https://www.archivesofmedicalscience.com/Cardiovascular-and-metabolic-effects-of-ovarian-suppression-in-combination-with-tamoxifen,190743,0,2.htmltamoxifenbreast cancercardiometabolicaromatase inhibitorovarian suppression |
| spellingShingle | Ying X. Gue Dorothy Lau Alena Shantsila Gregory Y.H. Lip Carlo Palmieri Cardiovascular and metabolic effects of ovarian suppression in combination with tamoxifen or an aromatase inhibitor as adjuvant therapy for early oestrogen receptor-positive breast cancer: a systematic review Archives of Medical Science tamoxifen breast cancer cardiometabolic aromatase inhibitor ovarian suppression |
| title | Cardiovascular and metabolic effects of ovarian suppression in combination with tamoxifen or an aromatase inhibitor as adjuvant therapy for early oestrogen receptor-positive breast cancer: a systematic review |
| title_full | Cardiovascular and metabolic effects of ovarian suppression in combination with tamoxifen or an aromatase inhibitor as adjuvant therapy for early oestrogen receptor-positive breast cancer: a systematic review |
| title_fullStr | Cardiovascular and metabolic effects of ovarian suppression in combination with tamoxifen or an aromatase inhibitor as adjuvant therapy for early oestrogen receptor-positive breast cancer: a systematic review |
| title_full_unstemmed | Cardiovascular and metabolic effects of ovarian suppression in combination with tamoxifen or an aromatase inhibitor as adjuvant therapy for early oestrogen receptor-positive breast cancer: a systematic review |
| title_short | Cardiovascular and metabolic effects of ovarian suppression in combination with tamoxifen or an aromatase inhibitor as adjuvant therapy for early oestrogen receptor-positive breast cancer: a systematic review |
| title_sort | cardiovascular and metabolic effects of ovarian suppression in combination with tamoxifen or an aromatase inhibitor as adjuvant therapy for early oestrogen receptor positive breast cancer a systematic review |
| topic | tamoxifen breast cancer cardiometabolic aromatase inhibitor ovarian suppression |
| url | https://www.archivesofmedicalscience.com/Cardiovascular-and-metabolic-effects-of-ovarian-suppression-in-combination-with-tamoxifen,190743,0,2.html |
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