Reducing heart risks in the wake of breast cancer treatment

Today, the vast majority of women diagnosed with breast cancer survive the disease—91% are still alive five years after their diagnosis. One reason for this is the use of hormone therapies. These drugs can treat — or prevent a recurrence of — estrogen-fueled tumors, which make up a majority (83%) of invasive breast cancers.

Hormonal medications are typically prescribed for five years following treatment to block the effects of estrogen on breast tissue. By hindering the action of this female hormone, these drugs can halt tumor growth. But while hormone therapies bring benefits, they also pose some risks to the heart and blood vessels.

A scientific statement from the American Heart Association, published online April 26, 2021, by Circulation: Genomic and Precision Medicine, outlined some of what’s known about the link between hormonal treatment for breast cancer and cardiovascular disease. It stressed the importance of recognizing and reducing risks for women who have been treated with hormone therapies.

“Survivors must remain vigilant about cardiovascular disease, which is still the leading cause of death among women who have had breast cancer,” says Dr. Kathryn Rexrode, chief of the Division of Women’s Health at ­Harvard-affiliated Brigham and ­Women’s Hospital.

Understanding risks

While several breast cancer treatments can affect cardiovascular health, the AHA statement looked specifically at the role played by hormone therapies.

There are two main types of hormones used:

  • aromatase inhibitors, which include anastrozole (Armidex), exemestane (Aromasin), and Femara (letrozole)
  • selective estrogen receptor modulators (SERMs), which include tamoxifen (Nolvadex), raloxifene (Evista), and toremifene (Fareston).

“The specific risks with regard to blood clots, heart attacks, strokes, lipids, high blood pressure, and heart failure depend on the specific hormonal agent prescribed,” says Dr. Rexrode.

Women treated with aromatase inhibitors, for example, may be more likely to develop plaque buildup in the arteries (also referred to as atherosclerosis), to experience heart failure, or to see an unhealthy rise in the levels of artery-clogging fats in their blood.

“Women treated with SERMs, on the other hand, may be at higher risk for blood clots, hypertension, and pulmonary hypertension,” says Dr. Rexrode.

Hypertension refers to high blood pressure that affects arteries throughout the body; people with pulmonary hypertension have elevated pressure only in the artery that feeds the lungs.

Reducing your risk

If you’ve undergone hormonal treatment for breast cancer, you can still make changes to protect the health of your heart and blood vessels over the long term. “The strategies for prevention of cardiovascular disease in women who have had breast cancer and hormonal therapies are similar to recommendations for the general population,” says Dr. Rexrode.

Women are advised to follow current guidelines designed to prevent cardiovascular disease. This includes reviewing your risk factors with your doctor and considering treatment if you are at increased risk, says Dr. Rexrode.

The American Heart Association and the American College of Cardiology have developed a risk calculator (/heartrisk) that allows you to assess your personal risk.

Additional female-specific risk factors aren’t always included in these calculations, but they’re also worth discussing with your doctor. These include having had an early menopause (before you turned 40) or pre-eclampsia (a potentially life-threatening pregnancy complication marked by high blood pressure and protein in the urine).

Women at elevated risk should closely monitor their blood pressure and get regular cholesterol and blood sugar tests.

“In addition, physical activity, a healthy diet, and maintaining a healthy weight can improve both cardiovascular and breast cancer risk,” says Dr. Rexrode.

And remember, increased risk doesn’t mean you are doomed to experience problems.

Bible verses for today’s meditation and inspiration: Matthew E. McLaren

2 Corinthians 10:5 ESV We destroy arguments and every lofty opinion raised against the knowledge of God, and take every thought captive to obey Christ,

Matthew 15:11 ESV It is not what goes into the mouth that defiles a person, but what comes out of the mouth; this defiles a person.”

Colossians 3:1-2 ESV If then you have been raised with Christ, seek the things that are above, where Christ is, seated at the right hand of God. Set your minds on things that are above, not on things that are on earth.

Proverbs 17:22 ESV A joyful heart is good medicine, but a crushed spirit dries up the bones.

Luke 21:34 ESV “But watch yourselves lest your hearts be weighed down with dissipation and drunkenness and cares of this life, and that day come upon you suddenly like a trap.

Proverbs 16:3 ESV Commit your work to the Lord, and your plans will be established.

Galatians 5:1 ESV For freedom Christ has set us free; stand firm therefore, and do not submit again to a yoke of slavery.

Matthew 7:7 ESV “Ask, and it will be given to you; seek, and you will find; knock, and it will be opened to you.

Romans 7:25 ESV Thanks be to God through Jesus Christ our Lord! So then, I myself serve the law of God with my mind, but with my flesh I serve the law of sin.

Jeremiah 29:11 ESV For I know the plans I have for you, declares the Lord, plans for welfare and not for evil, to give you a future and a hope.

Proverbs 3:5 ESV Trust in the Lord with all your heart, and do not lean on your own understanding.

Colossians 3:2-5 ESV Set your minds on things that are above, not on things that are on earth. For you have died, and your life is hidden with Christ in God. When Christ who is your life appears, then you also will appear with him in glory. Put to death therefore what is earthly in you: sexual immorality, impurity, passion, evil desire, and covetousness, which is idolatry.

Matthew 5:28 ESV But I say to you that everyone who looks at a woman with lustful intent has already committed adultery with her in his heart.

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