Aromatase Inhibitors and CardioVascular Health

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Aromatase Inhibitors and
CardioVascular Health

• Dr. A. Monnier

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Introduction and Study Objectives

• Cardiovascular (CV) disease is the main cause of
  death in women in Europe and the United States
• Postmenopausal women with breast cancer may
  exhibit comorbidities associated with CV disease
  aging, diabetes, and hypertension.
• The aromatase inhibitors (AIs) anastrozole
  (ANA), letrozole (LET), and exemestane (EXE) are
  quickly replacing TAM in the adjuvant treatment
  of early breast cancer.
• This study aimed to identify any differences in
  effects on CV health among the AIs

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Incidence of Hypercholesterolemia
AIs vs. TAM or PLAC

• When compared with PLA, LET and EXE are not
  associated with increased hypercholesterolemia or
  CV events. Increases in comparison with TAM may
  reflect the lipid-lowering effect of TAM.

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BIG 1-98

Effect of LET and TAM on total serum
cholesterol
As seen in BIG 1-98, the median total cholesterol
did not change significantly from baseline in
patients receiving LET and decreased by 13.5 in
patients receiving TAM
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Cardiovascular Events in Adjuvant AI Trials
According to the American Society of Clinical
Oncology in 2005, the current information is
insufficient to determine fully the effect of
aromatase inhibitors on cardiovascular disease,
especially coronary heart disease
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Ischemic cardiac event in BIG 1-98
versus with epidemiologic data
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Conclusions

• Comparing AIs with PLA may better indicate the
  impact of AIs on CV health
• ASCO and St. Gallen guidelines note no
  differences among AIs regarding CV safety.
• It is not possible to assign different CV risk
  profiles to individual AIs further analyses of
  ongoing AI trials are required.
• Lipid profiles and CV events will be assessed
  carefully in the large head-to-head trials
  comparing ANA with EXE (MA.27) and ANA with LET
  (FACE).

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The Femara Versus Anastrozole Clinical Evaluation
(FACE)
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MA.27 Trial Design