SERMs and cardiovascular disease in women. How do these agents affect risk?
The beneficial effects of SERMs, specifically tamoxifen in the treatment and prevention of breast cancer and raloxifene in the prevention of osteoporosis, are well established. In addition, numerous groups of investigators have reported that these agents have a positive impact on cardiovascular health, possibly as a result of their cholesterol-lowering and anticoagulation actions. Although studies clearly showed that tamoxifen therapy improved the levels of some types of lipids, the changes did not appear to translate into a decreased risk of cardiovascular disease. However, the risk of thromboembolic events (as well as endometrial cancer) was increased with the use of tamoxifen, which is often prescribed for breast cancer prevention in healthy women. Similarly, raloxifene treatment had modest positive effects on cardiovascular risk factors but was associated with an increased risk of thromboembolism. When viewed as a whole, study results dictate that the benefits of SERM use for the prevention of cardiovascular disease be carefully weighed against the potential risks.
Bush
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Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, 655 W Baltimore St, Baltimore, MD 21201, USA.
Blumenthal
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Lobo
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Clarkson
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TB
D001779:Blood Coagulation Factors / Q000187:drug effects; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D004968:Estrogens, Non-Steroidal / Q000494:pharmacology; D005260:Female; D006801:Humans; D007529:Isoflavones; D050356:Lipid Metabolism; D048789:Phytoestrogens; D028321:Plant Preparations; D020849:Raloxifene Hydrochloride / Q000494:pharmacology*; D020845:Selective Estrogen Receptor Modulators / Q000737:chemistry / Q000494:pharmacology*; D013025:Glycine max; D013629:Tamoxifen / Q000031:analogs & derivatives / Q000494:pharmacology*
D001779:Blood Coagulation Factors; D004968:Estrogens, Non-Steroidal; D007529:Isoflavones; D048789:Phytoestrogens; D028321:Plant Preparations; D020845:Selective Estrogen Receptor Modulators; D013629:Tamoxifen; D020849:Raloxifene Hydrochloride