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Hormonal therapies for breast and prostate cancer increase the risk of heart attack and stroke, the authors noted. This increased risk is greater in patients who already have two or more heart risk factors, such as high blood pressure, high cholesterol, obesity, smoking or a family history of heart disease or stroke.
What's more, the longer a patient receives hormonal therapy, the higher their risk of heart disease, according to the statement published April 26 in the journal Circulation: Genomic and Precision Medicine.
"A team-based approach to patient care that includes the oncology team, cardiologist, primary care clinician, dietitian, 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," statement writing group chair Dr. Tochi Okwuosa said.
Okwuosa is an associate professor of medicine and cardiology and director of cardio-oncology services at Rush University Medical Center in Chicago.
After skin cancers, hormone-dependent cancers such as prostate and breast cancer are the most common cancers in the United States and worldwide. Treatment improvements -- including greater use of hormonal therapies -- mean that more people with these cancers live longer, but heart disease has become a leading cause of illness and death in these patients.
Tamoxifen and aromatase inhibitors are two types of hormonal treatments for breast cancer. The statement authors reviewed existing research and found tamoxifen increases the risk of blood clots, while aromatase inhibitors increase the risk of heart attack and stroke more than tamoxifen.
In men, androgen deprivation therapy to reduce testosterone is a treatment for prostate cancer. But it increases cholesterol and triglyceride levels, boosts 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 heart attack, stroke, heart failure and cardiovascular death, according to the statement.
"For patients who have two or more cardiovascular risk factors, it is likely that referral to a cardiologist would be appropriate prior to beginning hormone treatment. For patients already receiving hormonal therapies, a discussion with the oncology team can help to determine if a cardiology referral is recommended," Okwuosa said in an AHA news release.
SOURCE: American Heart Association, news release, April 26, 2021
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