CM – AHA: Monitoring CVD Risks in Cancer Patients Receiving Hormone Therapy

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by
Mike Bassett,

Associate, MedPage Today

April 26, 2021

Patients undergoing hormone therapy for breast and prostate cancer may have an increased risk of cardiovascular disease (CVD) as they age and should be monitored closely, according to a scientific opinion by the American Heart Association (AHA) cardiovascular events are monitored.

The statement published online in Circulation: Genomic and Precision Medicine indicates that having two or more cardiovascular risk factors and the duration of hormone therapy increase the risk to patients.

« We know that there is data that hormone therapy for breast and prostate cancer increases the risk of cardiovascular disease and cardiovascular events, « said the chairman of the statement group, Tochi M. Okwuosa, DO, director of Cardio-Oncology Services am Rush University Medical Center in Chicago. « But there has never been a comprehensive review of these data or recommendations by any society or group. »

Okwuosa noted that hormonal agents are used for extended periods of time and that doctors should consider changes in cardiovascular risk factor while patients are being treated receive these therapies. « So this statement is really about creating awareness that these issues exist and how best to manage them, » Okwuosa told MedPage Today.

According to statistics from the American Cancer Society, in 2020 diagnosed with cancer in approximately 1.8 million people in the US, 5% of whom are considered at risk of heart disease. As the US population ages and cancer care improves, the number of cancer survivors is increasing (from an estimated 16.9 million in 2019 to an estimated 22.1 million in 2030), Okwuosa et al. Noted With this increase in the number of cancer survivors and the high prevalence of CVD in both patients and cancer survivors, clinicians need to be highly effective in detecting and preventing undesirable cardiovascular outcomes in this patient population, « wrote the AHA team. They found this to be especially important in prostate and breast cancers, as CVD has become a leading cause of mortality and morbidity in patients with these cancers.

Hormone treatments are a backbone of breast and prostate cancer treatment selective estrogen receptor modulators (such as tamoxifen and raloxifene) and aromatase inhibitors (such as exemestane, anastrozole, and letrozole) for breast cancer, and androgen deprivation therapy (ADT). for prostate cancer. While these therapies improve survival, they have also been known to increase cardiovascular risk in survivors.

The statement’s findings and recommendations are based on existing evidence from randomized controlled trials and observational studies, as Okwuosa and co-authors found. Main results are:

In addition, the authors found that a longer duration of hormone therapy can influence a patient’s risk of CVD. « Taken together, the evidence suggests that patients with breast and prostate cancer are more likely to develop both modifiable and unmodifiable risk factors that may worsen with prolonged duration of hormone therapy, » the AHA team wrote.

« It It is therefore important to identify patients receiving hormonal therapy who are at high risk of cardiovascular complications due to pre-existing uncontrolled cardiovascular risk factors or a history of CVD. These patients should then be closely monitored and treated for cardiovascular risk factors and CVD.  » Document states. « Physicians should take a team-based approach to managing these patients, » said Okwuosa. « The family doctor must be involved and the cardiologist – depending on the number of cardiovascular risk factors and whether the patient had an underlying cardiovascular disease – and of course the oncologist who treats the patient with these drugs. »

For further research in In that area, Okwuosa said there is a need for randomized trials evaluating hormone therapies with cardiovascular outcomes such as CVD and stroke as endpoints. In addition, further studies are required on differences in care between breast and prostate cancer patients who are undergoing hormone therapy.

Source: Okwuosa T, et al. « Influence of Hormonal Therapies for the Treatment of Hormone-Dependent Cancers (Breast and Prostate) on the Cardiovascular System: Effects and Changes: A Scientific Opinion from the American Heart Association » Circ Genom Precis Med 2021; DOI: 10.1161 / HCG.0000000000000082.

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