Is There Any Cardiovascular Concern Regarding the Use of Aromatase Inhibitors in Breast Cancer?

Breast cancer is the most frequent malignancy in women worldwide, and the second leading cause of cancer mortality. Due to advances in prevention, early detection and treatment, breast cancer mortality has decreased by nearly 40% during the last four decades. However, this optimistic scenario has been counterbalanced by an increasing risk from cardiovascular disease (CVD) in breast cancer survivors. Indeed, CVD is a leading cause of mortality in breast cancer survivors.^– The mechanisms by which these patients are at increased cardiovascular risk are multiple ones, including the effects of cancer itself (inflammation, oxidative stress, prothrombotic status, autonomic dysfunction, etc.) or due to the side effects related to chemotherapy and radiotherapy (metabolic dysfunction, cardiotoxicity). Some of these pathways may have prognostic significance: a previous investigation showed that autonomic modulation in breast cancer patients is an independent predictor of cardiovascular risk.

In this issue of the Arquivos Brasileiros de Cardiologia, the study “Changes in Cardiac Autonomic Modulation in Women with Breast Cancer Using Aromatase Inhibitors and the Relation with Biochemical Variables” was aimed to explore not breast cancer but the associations of one of its treatments (namely aromatase inhibitors, AI) with markers of autonomic dysfunction, as well as metabolic and inflammatory parameters in postmenopausal women. The rationale for exploring this specific therapy was based on a recent meta-analysis showing that prolonged AI use had a marginally effect of having a CVD event (odds ratio: 1.18, 95% CI = 1.00-1.40) as compared to placebo.

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