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The study covered in this summary was published as a preprint and has not yet been peer reviewed.

Key Takeaway

  • Researchers found no association between aromatase inhibitor exposure and early cardiovascular damage in young breast cancer survivors more than a decade after their diagnosis.  

Why This Matters

  • Aromatase inhibitors are an important component of the adjuvant treatment of hormone receptor-positive breast cancer, but the cardiovascular safety of these drugs has remained unclear.

  • The results are “reassuring,” the investigators say, given the “substantial” oncological benefits of aromatase inhibitors.

Study Design

  • The researchers assessed 569 breast cancer survivors for three early markers of cardiovascular disease: carotid intima media thickness (cIMT), lovex official homepage advanced glycation end products in the skin (AGEs), and dyslipidemia.

  • For 277 women, 5 to 7 years had passed since their breast cancer diagnosis, and for the remaining 292, 10 to 12 years had passed.

  • The women were mainly pre-/perimenopausal at the time of their diagnosis and a median of 55.5 years old at study entry. 

  • To quantify aromatase inhibitor exposure, researchers divided the duration of aromatase inhibitor use by the total duration of endocrine therapy.

  • The authors then classified patients into aromatase inhibitor exposure groups: low (no endocrine therapy or aromatase inhibitor ratio < 0.40), intermediate (aromatase inhibitor ratio 0.40-0.60), or high (aromatase inhibitor ratio > 0.60).

Key Results

  • Overall, 40% of the study population had taken aromatase inhibitors, most of whom had received tamoxifen. The median duration of therapy was 3 years.

  • Mean cIMT and AGEs did not differ across low-to-high aromatase inhibitor exposure groups in univariable and multivariable analyses.

  • The occurrence of dyslipidemia did not vary across aromatase inhibitor exposure groups.

  • Intermediate aromatase inhibitor exposure was associated with a twofold higher risk of the combined endpoint — elevated cIMT, AGEs, and dyslipidemia — compared with no or low aromatase inhibitor exposure.

  • However, this association was not observed in the group with the highest aromatase inhibitor exposure.


  • Women who developed severe cardiovascular disease may have died prior to the study.

  • Duration of follow-up may have been too short for vascular abnormalities to develop in a relatively young and healthy population.

  • The findings need to be validated in patients with breast cancer at higher risk for cardiovascular disease.


  • The work was funded by the Dutch Cancer Society.

  • One investigator is a consultant for Biovica and Seagen, and several disclosed receiving research support from AbbVie and AstraZeneca, among other companies.

This is a summary of a preprint research study, “Adjuvant aromatase inhibitor therapy and early markers for cardiovascular disease in breast cancer survivors,” led by Annemiek Van Ommen-Nijhof of the Antoni van Leeuwenhoek Netherlands Cancer Institute. The study has not been peer reviewed. The full text can be found at researchsquare.com.

M. Alexander Otto is a physician assistant with a master’s degree in medical science and a journalism degree from Newhouse. He is an award-winning medical journalist who worked for several major news outlets before joining Medscape and is also an MIT Knight Science Journalism fellow. Email: [email protected]

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