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The hormone therapies used to treat many breast and prostate cancers increase the risk of heart attacks and strokes. According to a new scientific opinion from the American Heart Association, patients should be monitored and treated regularly to reduce risk and identify problems that may arise. published today in the journal Circulation: Genomic and Precision Medicine of the Association.
“The statement includes data on the risks of each type of hormone therapy so that clinicians can use it as a guide to managing cardiovascular risks during cancer treatment,” said Tochi M. Okwuosa, DO, FAHA, chair of the Scientific Statement Writing Group. Professor of Medicine and Cardiology and Director of Cardiovascular Services at Rush University Medical Center in Chicago.
Hormone-dependent cancers such as prostate and breast cancer are the most common cancers in the US and worldwide excluding skin cancer. As improvements in treatment – including increased use of hormonal therapies – allow people with these cancers to live longer lives, cardiovascular disease has emerged as the leading cause of illness and death in these patients.
Hormonal treatments for breast cancer include selective estrogen receptor modulators (SERMs) and aromatase inhibitors (AIs). SERMs block estrogen receptors in cancer cells so that the hormone cannot stimulate tumor growth, while estrogen can function normally in other tissues such as bone and liver tissue. Examples of SERMs include tamoxifen and raloxifene. Aromatase inhibitors lower the amount of estrogen produced in postmenopausal women and include exemestane, anastrozole, and letrozole. Endocrine treatments for prostate cancer called androgen deprivation therapy include some drugs that reduce testosterone production by acting on the brain and others that block testosterone receptors found in prostate cells and some prostate cancer cells.
The writing group reviewed existing evidence from observational studies and randomized controlled trials and found that:
- Tamoxifen increases the risk of blood clots, while aromatase inhibitors increase the risk of heart attack and stroke more than tamoxifen. Breast cancer patients who require more than one type of hormone therapy because of the resistance to the original medication that has developed, experience an improvement in cancer outcomes. However, treatment with multiple hormones has been linked to higher rates of cardiovascular disease such as high blood pressure, abnormal heart rhythms, and blood clots.
- Androgen deprivation therapy (used to reduce testosterone levels) in prostate cancer increases cholesterol and triglyceride levels, adds body fat, decreases muscles, and affects the body’s ability to process glucose (which can lead to type 2 diabetes). These metabolic changes are linked to a higher risk of heart attacks, strokes, heart failure, and cardiovascular death.
- The longer people receive hormone therapy, the greater the risk of cardiovascular problems. Further research is needed to better define the risks associated with duration of treatment.
- The increase in the risk of CVD associated with hormone therapy was greatest in people who had a history of heart disease or two or more cardiovascular risk factors – such as: When they started treatment – such as high blood pressure, obesity, high cholesterol, smoking, or a family history of heart disease or stroke.
“A team-based approach to patient care that includes the oncologist team, cardiologist, primary care practitioner, nutritionist, endocrinologist and other health care professional is required to work with every patient and manage the increased risk of heart disease and stroke decrease related to hormone therapy in the treatment of breast and prostate cancer, “said Okwuosa.
There are currently no definitive guidelines for the monitoring and management of hormone therapeutic cardiac risks. The statement called for doctors to watch out for worsening heart problems in patients with previous heart disease or risk factors, and to recognize that patients without pre-existing heart problems are also at higher risk due to their exposure to hormone therapy.
“For patients with two or more cardiovascular risk factors, a referral to a cardiologist is likely to be appropriate prior to initiating hormone therapy. For patients already receiving hormonal therapy, a discussion with the oncology team can help determine whether a cardiologist is due recommended, “said Okwuosa.
The declaration also calls for additional research in several areas, including:
- Further assess the racial and ethnic differences in breast and prostate cancer patients who received hormone therapy. In the few studies that exist, identified racial and ethnic differences may be related to health inequalities and other factors, and these are important areas that need to be addressed.
- Heart disease and stroke outcomes and risks should be added as primary endpoints in randomized trials of hormone therapy.
- Studies of specific hormonal drugs are needed because each can have different heart risks, even if they work in the same way to treat breast or prostate cancer.
This scientific statement was prepared by the volunteer writing group on behalf of the American Heart Association’s Cardio-Oncology Subcommittee of the Council on Clinical Cardiology and the Council on Genomic and Precision Medicine. the Council for Atherosclerosis, Thrombosis and Vascular Biology; and the Council on Cardiovascular Radiology and Intervention.
Cancer can cause heart changes before treatment
Circulation: Genomic and Precision Medicine, DOI: 10.1161 / HCG.0000000000000082 Provided by the American Heart Association
Quote: Close heart risk monitoring is needed if breast and prostate cancer treatment includes hormones (2021 April 26) released on April 26, 2021 from https://medicalxpress.com/news/2021-04-heart- breast-prostate-cancer-treatment. html
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