Hormone therapies for the treatment of breast and hormone dependent prostate cancer could increase the risk of myocardial infarction (MI) i stroke, and patients should be closely monitored to allow early detection and treatment of cardiovascular disease (CVD), according to the American Heart Association (AHA) in a new scientific statement.
“The statement provides data on the risks of each type of hormone therapy for clinicians to use as a guide to help manage cardiovascular risks during cancer treatment,” said Tochi Okwuosa, DO, chair of the drafting group. .
“A team-based approach to patient care is needed that includes the oncology team, cardiologist, primary care physician, dietitian, endocrinologist, and other health professionals, as appropriate, to work with each patient to manage and reduce the increased risk of heart disease and stroke associated with hormone therapy in the treatment of breast and prostate cancer, “said Okwuosa, director of cardio-oncology services, Rush University Medical Center, Chicago.
The scientific statement was published online April 26 a Circulation: genomic and precision medicine.
Hormone – dependent cancers, such as prostate and Lung cancer, are the most common non-skin cancers in the United States and around the world. Because hormone therapies have significantly improved survival in these patients, cardiovascular disease has become one of the leading causes of illness and death.
The increased burden of cardiovascular disease could be explained by the growing average age of cancer survivors, leading to higher rates of age-related CV risk factors and coronary artery disease.
The drafting group reviewed existing evidence from observational studies and randomized controlled trials on the cardiovascular impact of anticancer hormone therapies.
Among the main conclusions:
In breast cancer patients, tamoxifiers It has been shown to increase the risk of venous thromboembolic events, but has somewhat protective effects against neutral effects on cardiovascular disease risk burden and cardiovascular disease events. Conversely, aromatase inhibitors have been shown to increase the risk of MCV risk factors and events, including MI and stroke.
Androgen deprivation therapy for prostate cancer appears to increase the risk of CV events, although gonadotropin-releasing hormone (GnRH) antagonists are associated with a lower risk of CV events than agonists. of GnRH. Oral antiandrogens appear to be associated with an increased risk of cardiovascular disease, especially when used for complete androgen blockade as a combination of GnRH anti-androgen therapy.
The duration of hormone therapies has a significant impact on the risk of CVD; the longer patients receive hormone therapy, the greater the risk. More research is needed to better define the risks associated with the duration of treatment.
Data are shuffled on the impact of pre-existing CV risk factors and CVD on CV events associated with hormone therapy. Although the presence of baseline CV and CVD risk factors may increase CV events associated with aromatase inhibitors, it is not clear that tamoxifen does.
Studies suggest that patients with prostate cancer and baseline risk factors for CVD and CV show an increased rate of CV events when treated with androgen deprivation therapy.
Although prolonged use of some hormonal therapies worsens CV and risk factors metabolic syndrome, the effects of therapy duration on CV events are less clear.
The drafting group says there are currently no definitive guidelines for monitoring and managing the risks of hormone-related cardiovascular disease.
Clinicians are encouraged to be alert to worsening CV problems in those with pre-existing heart disease or risk factors and to recognize that even patients without pre-existing CV problems have a higher risk due to their exposure to therapies. hormonal.
“For patients who have two or more cardiovascular risk factors, referral to a cardiologist is likely to be appropriate before starting hormone treatment. For patients who are already receiving hormone therapies, a discussion with the oncology team can help determine if a cardiology referral is recommended, ”Okwuosa said in the press release.
This scientific statement was prepared by the volunteer writing group on behalf of the AHA cardio-oncology subcommittee of the Clinical Cardiology Council and the Council for Genomic and Precision Medicine; the Council on Arteriosclerosis, Thrombosis and Vascular Biology; and the Board of Radiology and Cardiovascular Intervention.
The research had no commercial funding. Okwuosa has not revealed any relevant financial relationship.
Circ Genom Precis Med. Published online April 26, 2021. Full text