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Meta-Analysis Weighs Aromatase Inhibitors' Cardiovascular Risks


 

COLORADO SPRINGS — The cardiovascular disease risk profile of the third-generation aromatase inhibitors is a mixed bag, compared with that of the antiestrogen tamoxifen, Eric L. Ding, Sc.D., reported at a conference of the American Heart Association.

His meta-analysis demonstrated lower risks of thromboembolic and cerebrovascular events with anastrozole and letrozole, compared with tamoxifen, but higher rates of hypercholesterolemia and coronary heart disease (see chart). Anastrozole and letrozole are increasingly replacing tamoxifen for long-term secondary preventive therapy in breast cancer patients.

The meta-analysis included six randomized, tamoxifen-controlled trials of anastrozole and two of letrozole totalling 18,548 postmenopausal breast cancer patients. During follow-up there were 342 coronary events, 237 cerebrovascular events, and 432 cases of thromboembolism, said Dr. Ding of Harvard School of Public Health, Boston. Neither AI was tied to a significant rise in CHD or stroke in placebo-controlled studies, he noted.

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