Antiatherogenic effects of adjuvant antiestrogens: a randomized trial comparing the effects of tamoxifen and toremifene on plasma lipid levels in postmenopausal women with node-positive breast cancer.
OBJECTIVE
To evaluate whether a novel antiestrogen, toremifene, has similar antiatherogenic effects as tamoxifen.


METHODS
Forty-nine postmenopausal patients with node-positive breast cancer were randomized in a trial that compared the effects of tamoxifen and toremifene on serum lipoproteins. Tamoxifen was given at 20 mg and toremifene at 60 mg orally per day for 3 years. Serum concentrations of apolipoprotein (apo) A-I, A-II, and B, and lipoprotein(a) [Lp(a)], cholesterol, triglyceride, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol were measured before and after 12 months of antiestrogen therapy.


RESULTS
Both antiestrogens significantly reduced serum total and LDL cholesterol and apo B levels. However, the response of HDL cholesterol to treatments was clearly different between the groups. Toremifene increased the HDL level by 14%, whereas tamoxifen decreased it by 5% (P = .001). As a consequence, both cholesterol-to-HDL and LDL-to-HDL ratios decreased more in the toremifene than tamoxifen group (P = .008 and P = .03, respectively). Toremifene also increased the apo A-I level (P = .00007) and apo A-I-to-A-II ratio (P = .018). Both tamoxifen and toremifene decreased the Lp(a) concentration significantly (change, 34% v 41%).


CONCLUSIONS
These results provide positive evidence that toremifene has antiatherogenic properties with potency to improve all lipoproteins that are associated with increased coronary heart disease (CHD) risk.
Saarto
T
T
Department of Oncology, Helsinki University Central Hospital, Finland.
Blomqvist
C
C
Ehnholm
C
C
Taskinen
M R
MR
Elomaa
I
I
D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D001053:Apolipoproteins / Q000097:blood; D001943:Breast Neoplasms / Q000097:blood* / Q000188:drug therapy; D002784:Cholesterol / Q000097:blood; D004965:Estrogen Antagonists / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008055:Lipids / Q000097:blood*; D008074:Lipoproteins / Q000097:blood*; D008875:Middle Aged; D017698:Postmenopause; D013629:Tamoxifen / Q000627:therapeutic use*; D017312:Toremifene / Q000627:therapeutic use*; D014280:Triglycerides / Q000097:blood
D018931:Antineoplastic Agents, Hormonal; D001053:Apolipoproteins; D004965:Estrogen Antagonists; D008055:Lipids; D008074:Lipoproteins; D014280:Triglycerides; D013629:Tamoxifen; D017312:Toremifene; D002784:Cholesterol