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Old 05-20-2014, 09:15 AM   #1
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Post Cardiac outcomes in women receiving aromatase inhibitors as adjuvant endocrine therap

Cardiac outcomes in women receiving aromatase inhibitors as adjuvant endocrine therapy for breast cancer.

Abstract No:
Publication-only abstracts (abstract number preceded by an "e"), published in conjunction with the 2014 ASCO Annual Meeting but not presented at the Meeting, can be found online only.

Author(s): Esther Park, Maysa M. Abu-Khalaf, Christos Hatzis, Johanna M. LaSala, Andrea Silber, Erin Wysong Hofstatter, Tara Beth Sanft, Raymond Russell; Yale School of Medicine, New Haven, CT; Yale Cancer Center, Yale School of Medicine, New Haven, CT; Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT
Abstract Disclosures


Background: Aromatase inhibitors (AIs) have been reported to increase the risk of cardiotoxicity in women with early stage breast cancer (BC). This study was performed to further elucidate the cardiac side effects and associated risk factors. Methods: We retrospectively identified 496 women in the Yale Nuclear Cardiology database who were diagnosed with BC between August 2003 and April 2011. Their records were reviewed for treatment histories and baseline risk factors (age, BMI, CAD, HTN, DM, smoking, and family history of cardiac disease). The patients (pts) were divided into mutually exclusive groups according to what they received as endocrine therapy: 1) tamoxifen, 2) AIs, 3) sequential (tamoxifen + AIs, in either order), and 4) none. The endpoint was cardiac ischemia, based on a diagnosis of myocardial infarction or an abnormal stress test. Results: Median age was 51 (range 26-83). There were 67 (14%) in the tamoxifen group, 168 (34%) in the AI group, 125 (25%) in the sequential group, and 136 (27%) in the no endocrine therapy group. Fifteen pts (3%) experienced cardiac ischemia; 10 were in the AI group (6.0%), 1 in the tamoxifen group (1.5%), 1 in the sequential group (0.8%), and 3 in the no endocrine therapy group (2.2%). The sequential group had a significantly lower incidence of cardiac ischemia compared to the AI group (OR=0.128, 95% CI 0.003-0.922, p=0.027). By logistic regression, older age, smoking, and left sided irradiation (LSI) were significantly associated with cardiac ischemia (OR=1.122, 95% CI 1.038-1.212, p=0.004; OR=4.920, 95% CI 1.143-21.173, p=0.032; and OR=4.239, 95% CI 1.135-15.832, p=0.032 respectively). Anthracycline and/or herceptin exposure were not associated with increased risk. Conclusions: The sequential group experienced a significantly lower incidence of cardiac ischemia compared to the AI group. The results suggest that AIs have cardiotoxic effects that can be modulated by tamoxifenís potentially cardioprotective effects. Older age, smoking, and LSI were the only risk factors significantly associated with cardiac ischemia. Based on these findings, pts receiving AIs alone should be monitored for evidence of cardiac ischemia and have aggressive risk factor modification.
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