Close Monitoring for Heart Risk Needed if Breast, Prostate Cancer Treatment Includes Hormones

April 27, 2021
The hormonal therapies used to treat many breast and prostate cancers increase the risk of a myocardial infarction (MI) and stroke, and patients should be monitored regularly and receive treatment to reduce risk and detect problems as they occur, according to a new American Heart Association scientific statement, published in the journal Circulation: Genomic and Precision Medicine. “The statement provides data on the risks of each type of hormonal therapy so clinicians can use it as a guide to help manage cardiovascular risks during cancer treatment,” said Tochi M. Okwuosa, MD, Rush University Medical Center, Chicago, Illinois. The writing group reviewed existing evidence from observational studies and randomised controlled trials and found that tamoxifen increases the risk of blood clots, while aromatase inhibitors increase the risk of MI and stroke more than tamoxifen. For patients with breast cancer who require more than 1 type of hormonal therapy because of developed resistance to the initial medication, there is an improvement in cancer outcomes; however, treatment with multiple hormones is associated with higher rates of cardiovascular conditions such as high blood pressure, abnormal heart rhythms, and blood clots. Androgen-deprivation therapy (ADT) for prostate cancer increases cholesterol and triglyceride levels, adds body fat while decreasing muscle, and impairs the body’s ability to process glucose (which may result in type 2 diabetes). These metabolic changes are associated with a greater risk of MIs, strokes, heart failure, and cardiovascular death. The longer people receive hormonal therapy, the greater the increased risk of cardiovascular problems. Further research is required to better define the risks associated with duration of treatment. The hormonal therapy-associated increase in cardiovascular disease risk was highest in people who already had heart disease or those who had ≥2 cardiovascular risk factors when they began treatment. “A team-based approach to patient care that includes the oncology team, cardiologist, primary care clinician, dietician, endocrinologist, and other health care professionals as appropriate is needed to work with each patient to manage and reduce the increased risk of heart disease and strokes associated with hormonal therapy in breast and prostate cancer treatment,” said Dr. Okwuosa. There are currently no definitive guidelines for monitoring and managing hormonal therapy-related heart risks. The statement calls for clinicians to be alert for worsening heart problems in those with prior heart disease or risk factors, and to recognise that even those without pre-existing heart problems are at higher risk because of their exposure to hormonal therapies. “For patients who have ≥2 cardiovascular risk factors, it is likely that referral to a cardiologist would be appropriate prior to beginning hormone treatment,” said Dr. Okwuousa. “For patients already receiving hormonal therapies, a discussion with the oncology team can help to determine if a cardiology referral is recommended.” Reference: https://www.ahajournals.org/doi/abs/10.1161/HCG.0000000000000082 SOURCE: American Heart Association