Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2022 Jan-Dec:29:10732748221132512.
doi: 10.1177/10732748221132512.

Association Between Aromatase Inhibitors and Myocardial Infarction Morbidity in Women With Breast Cancer: A Meta-Analysis of Observational Studies

Jing-Chao Sun  1   2 , Ze-Fan Sun  1   2 , Chao-Jie He  2 , Chang-Lin Zhai  2 , Gang Qian  2
Affiliations
Meta-Analysis

Association Between Aromatase Inhibitors and Myocardial Infarction Morbidity in Women With Breast Cancer: A Meta-Analysis of Observational Studies

Jing-Chao Sun et al. Cancer Control. 2022 Jan-Dec.

Abstract

Background: The cardiovascular toxicity of aromatase inhibitors (AIs) for women with estrogen receptor-positive breast cancer is controversial. We aimed to evaluate the association between AIs and the risk of myocardial infarction (MI) in women with estrogen receptor-positive breast cancer based on real-world studies.

Method: PubMed, Embase, and Cochrane Library were searched to identify studies that estimated the association between MI risk and AIs. A random-effects model was used to evaluate the hazard ratio (HR) and 95% confidence intervals (CIs) of the predefined outcomes.

Results: A total of 134 476 patients from eight cohort studies were enrolled in our analysis. For MI incidence, no significant difference was found between the users of AIs and non-users (HR: .98, 95% CI: .83-1.17). The subgroup analysis of patients without a history of cardiovascular disease (CVD) suggested a reduced risk of MI (HR: .86, 95% CI: .77-.96). No significant difference was found for ischemic stroke (HR: .93, 95% CI: .82-1.07) and heart failure (HR: 1.24, 95% CI: .92-1.66) between the two groups.

Conclusion: Based on real-world data, AIs may be a safe treatment route for patients with estrogen receptor-positive breast cancer and those with a history of CVD. AIs caused a major decrease in MI in patients without CVD history. However, more in-depth investigations are needed to explore the association between AI use and the incidence of MI in the treatment of estrogen receptor-positive breast cancer.

Keywords: aromatase inhibitors; breast cancer; meta-analysis; myocardial infarction; tamoxifen.

PubMed Disclaimer

Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Flow diagram showing search strategy and inclusion and exclusion of studies for meta-analysis.
Figure 2.
Figure 2.
Contour-enhanced funnel plot for the association between AIs and MI.
Figure 3.
Figure 3.
The forest plot for the association between AIs and MI.
Figure 4.
Figure 4.
The forest plot for the association between AIs and IS.
Figure 5.
Figure 5.
The forest plot for the association between AIs and HF.
Figure 6.
Figure 6.
Subgroup analysis based on CVD history for the association between AIs and HF.
See this image and copyright information in PMC

References

    1. Ghoncheh M, Pournamdar Z, Salehiniya H. Incidence and mortality and epidemiology of breast cancer in the world. Asian Pac J Cancer Prev. 2016;17(S3):43-46. doi: 10.7314/apjcp.2016.17.s3.43. - DOI - PubMed
    1. National Comprehensive Cancer Network (NCCN) . Clinical Practice Guidelines in Oncology. Breast Cancer Version 4. 2021; 2021. https://www.nccn.org/professionals/physician_gls/pdf/breast.pdf. Accessed 6 March 2021.
    1. Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) . Aromatase inhibitors versus tamoxifen in early breast cancer: Patient-level meta-analysis of the randomised trials. Lancet. 2015;386(10001):1341-1352. doi: 10.1016/S0140-6736(15)61074-1. Epub 2015 Jul 23. - DOI - PubMed
    1. Upshaw JN, Hubbard RA, Hu J, et al. Physical activity during and after breast cancer therapy and associations of baseline physical activity with changes in cardiac function by echocardiography. Cancer Med. 2020;9(17):6122-6131. doi: 10.1002/cam4.3277. Epub 2020 Jul 9. - DOI - PMC - PubMed
    1. Khosrow-Khavar F, Filion KB, Al-Qurashi S, et al. Cardiotoxicity of aromatase inhibitors and tamoxifen in postmenopausal women with breast cancer: A systematic review and meta-analysis of randomized controlled trials. Ann Oncol. 2017;28(3):487-496. doi: 10.1093/annonc/mdw673. - DOI - PMC - PubMed

Publication types