Effect of Aromatase Inhibitor Therapy on the Cardiovascular Health of Black and White Breast Cancer Patients

Long-term effects of aromatase inhibitors on body mass index among postmenopausal breast cancer survivors in Africa: observational cohort study

PURPOSE

this study was conducted to assess the impact of AIs on body mass index and high sensitivity as prognostic predictors to be incorporated into point of care technology (POCT) testing in postmenopausal breast cancer women after a 24 month follow up in Africa. An observational cohort study was conducted; including 126 female BC patients with stages ranging from 0-III initially subjected to AIs and subsequently followed up for 24 months. Multiple imputation model was conducted to predict missing data.

RESULTS

Random effects model was used to monitor the changes over the time. The study revealed stronger statistically association between BMI and homocysteine (p = 0.021, 95%CI: 0.0083 to 0.1029). Weight and total body fat were strongly associated after 24 months follow up. Hs-CRP was associated with BMI (p = 0.0001), and hs-CRP was associated with other biomedical markers such as calcium (p = 0.021, 95% CI: 0.01 to 0.10), phosphate (p = 0.039, 95%CI: 0.01 to 0.10), and ferritin (p = 0.002, 95%CI: 0.02 to 0.08) and calcium. The patients subjected to AIs are likely to develop cardiovascular adverse events. POCT of care strategy which include clinical, biomedical and genetic predictor's measurement is required to improve BC survivorship.

Adjuvant aromatase inhibitor therapy and early markers for cardiovascular disease in breast cancer survivors

PURPOSE

Aromatase inhibitors (AIs) are an important component of the adjuvant treatment of hormone receptor positive breast cancer (BC) but concerns regarding their cardiovascular safety remain. In this cross-sectional study nested in a breast cancer cohort, we investigated the association between AI exposure and early markers for cardiovascular disease in BC survivors.

METHODS

The study population consisted of 569 women, who were 5-7 years (n = 277) or 10-12 years (n = 292) after BC diagnosis. All participants underwent carotid ultrasound, skin autofluorescence measurement and laboratory evaluation. To quantify AI exposure, we obtained the AI ratio by dividing the duration of AI use by the total duration of endocrine therapy (ET). Patients were classified according to their AI ratio into low (no ET or AI ratio < 0.40), intermediate (0.40 ≤ AI ratio ≤ 0.60) or high AI exposure (AI ratio > 0.60). The association between AI ratio and carotid intima media thickness (cIMT), advanced glycation end products (AGEs) and the presence of dyslipidemia was assessed using linear and logistic regression.

RESULTS

Median age at study visit was 55.5 years (range 45.2-63.8). Forty percent (n = 231) of the study population had used AIs, of whom the majority sequentially with tamoxifen; median duration of AI use was 3.0 years. Mean cIMT and mean AGEs did not differ across AI exposure groups in univariable and multivariable analysis. The occurrence of dyslipidemia did not vary across AI exposure groups. Intermediate AI exposure was associated with more frequent occurrence of the combined endpoint (elevated cIMT, elevated AGEs and/or dyslipidemia). This association, however, was not present in the group with highest AI exposure.

CONCLUSION

AI exposure was not associated with cIMT, AGEs or the presence of dyslipidemia. These results do not prompt a change in current clinical practice, although further research is warranted to validate our findings over time and in different BC populations. Trial registration number (clinicaltrials.gov): NCT02485626, June 30, 2015.

Grip Strength in Women Being Treated for Breast Cancer and Receiving Adjuvant Endocrine Therapy: Systematic Review

BACKGROUND

Adjuvant endocrine therapy in breast cancer has increased survival rates; however, it is not without musculoskeletal side effects.

PURPOSE

The purpose of this review was to systematically and critically appraise the available scientific evidence concerning the effect of adjuvant endocrine treatment on grip strength in women being treated for breast cancer.

DATA SOURCES AND STUDY SELECTION

The National Library of Medicine (MEDLINE-PubMed), Cochrane Central Register of Controlled Trials (CENTRAL), Excerpta Medical Database by Elsevier (EMBASE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Physiotherapy Evidence Database (PEDro) were searched from inception to February 2017 for appropriate papers that could answer the focused question. The searches were independently screened by 2 reviewers. The data from 7 papers that met the eligibility criteria were processed for further analysis.

DATA EXTRACTION AND SYNTHESIS

The collective data and the statistical analysis of all included studies were summarized and presented in a descriptive manner. If not provided, based on data from the individual included studies, a mean percent change in grip strength was calculated. The included studies evaluating aromatase inhibitors had inconclusive outcomes, and studies with a follow-up of 6 or 12 months showed a percent reduction in grip strength varying from 0.1% to 9.7%. None of the included studies showed a significant decrease in grip strength in tamoxifen users, with a percent reduction in grip strength varying from 1.4% to 2.2%.

LIMITATIONS

The 7 studies included cohort studies lacking a control group.

CONCLUSIONS

There is inconclusive evidence for a small decrease in grip strength in women treated for breast cancer who are also receiving aromatase inhibitors. In those that use tamoxifen, grip strength did not change significantly.

Relationship between physical activity practice and metabolic profile of postmenopausal women under treatment with aromatase inhibitors for breast cancer

OBJECTIVE

To analyze the relationship between physical activity practice and metabolic profile of postmenopausal women under treatment with aromatase inhibitors (AIs) for the treatment of breast cancer.

STUDY DESIGN

Cross-sectional study, conducted with 101 postmenopausal women (aged 50-80 years). The sample was divided into two groups; group without cancer (GW; n=65) and breast cancer group treated with AIs (GC; n=36). Physical activity (PA) was evaluated by questionnaire. Correlations between physical activity and metabolic variables were made by Pearson's correlation coefficient and the magnitude of these relationships by linear regression.

RESULTS

In GW, there were observed significant inverse correlations between physical activity and VLDL cholesterol (β=-0.036; 95% CI=-0.068; -0.004); triglycerides (β=-0.036; 95% CI=-0.015; -0.002); glycose (β=-0.029; 95% CI=-0.047; -0.012); and C-reactive protein (β=-0.44; 95% CI=-0.085; -0.003). However, for women under treatment of AIs there was no relationship between physical activity and metabolic variables.

CONCLUSION

The amount of physical activity practice is inversely related to lipid profile, glucose and C-reactive protein in women without breast cancer. This relation was not observed in the cancer survivors, suggesting that the use of aromatase inhibitors could influence or low intensity of physical activity.