The effect of endocrine therapy for breast cancer on blood lipids in postmenopausal women
Keywords:hormone-sensitive breast cancer, dyslipidemia, serum lipid profile, adjuvant endocrine therapy for breast cancer, selective estrogen receptor modulators, aromatase inhibitors
AbstractBackground. Breast cancer ranks first in the world among all malignant neoplasms in women. The proportion of hormone-sensitive breast cancer in the morbidity structure is more than 60 %. Adjuvant endocrine therapy is an integral part of postoperative treatment of patients with hormone-sensitive breast cancer. Recent publications suggest that breast cancer endocrine therapy has some effect on serum lipid levels. However, the number of studies focusing exclusively on this problem is insignificant, and the question about the nature of the effect of various drugs for breast cancer endocrine therapy on the lipid profile remains controversial. A significant proportion of patients with hormone-sensitive breast cancer are women with natural or artificial postmenopause. In the group of patients aged 60 years and older, diseases of the cardiovascular system rank first in the structure of mortality. Thanks to modern approaches to the treatment of breast cancer, the overall survival has increased significantly, and a comprehensive approach to the treatment of patients with age-related comorbidities, no less important in terms of duration and quality of life, has become relevant. This article discusses the effect of the most common endocrine therapies on the lipid profile, which is extremely relevant for the prevention of morbidity and mortality from cardiovascular events in postmenopausal women. Materials and methods. This article is based on the results of 13 clinical studies obtained in the search resource PubMed on the keywords: “hormone-sensitive breast cancer”, “dyslipidemia”, “serum lipid profile”, “adjuvant endocrine therapy for breast cancer”, “selective estrogen receptor modulators”, “aromatase inhibitors”; NCCN clinical guidelines; clinical guidelines of the European Society of Cardiology and the European Atherosclerosis Society for the treatment of dyslipidemia. Results. Selective estrogen receptor modulators have a positive effect on the lipid profile with some differences between toremifene and tamoxifen (does not cause an increase in triglycerides). Aromatase inhibitors, according to the studies, have a rather neutral effect; among common aromatase inhibitors, letrozole has the most pronounced negative effect on the lipid profile of postmenopausal women with hormone-sensitive breast cancer. Conclusions. Selective estrogen receptor modulators may be the drugs of choice for patients at high risk of dyslipidemia, other than women with isolated hypertriglyceridemia. The use of aromatase inhibitors should be accompanied by a closer monitoring of lipid metabolism and may require additional prescription of lipid-lowering drugs (statins, fibrates, bile acid sequestrants, etc.). The problem needs further study, taking into account the attention paid to the correction of dyslipidemia as a mean for preventing the development of diseases of the cardiovascular system, which are the leading cause of death in the studied age group.
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