Effect Of Aromatase Inhibitors On Blood Lipids In Postmenopausal Patients With Breast Cancer

Objective: The effects of three Aromatase Inhibitors(AIs)on blood lipid levels(TG,TC,HDL-C,LDL-C)in postmenopausal patients with breast cancer were retrospectively analyzed.We compare the effects between non-steroidal(Letrozole,Anastrozole)and steroidal(Exemestane)Aromatase Inhibitors on blood lipids.And compare the effects of two non-steroidal(Letrozole,Anastrozole)aromatase inhibitors on blood lipids.The results of this study provide a scientific basis for whether it is necessary to take lipid-lowering intervention for patients with long-term AIs,and determine the intervention time,so as to consider whether to stop the drug,add or switch to other drugs,regulate the blood lipid level of patients and prevent the occurrence of adverse cardiovascular events.Methods: A total of 120 breast cancer patients who underwent surgical treatment,radiotherapy or chemotherapy and adjuvant endocrine therapy in the Department of Thyroid and Breast Surgery of The Central Hospital of Wuhan from June 2012 to June 2021 were collected.According to the use of aromatase inhibitors,patients who met the inclusion criteria were divided into Letrozole group(2.5mg,qd),Anastrozole group(1mg,qd)and Exemestane group(25mg,qd).The effects of three different AIs on triglycerides(TG),total cholesterol(TC)and high-density lipoprotein(HDL-C)at different time points before and after treatment were retrospectively analyzed.HDL-C,low-density lipoprotein(LDL-C)and other blood lipids.Results: In the Letrozole group,TG and LDL-C levels increased by 17.1% and16.7%,respectively,compared with baseline levels before treatment,while HDL-C levels decreased by 8.2% and TC levels did not change at 3 years.In the Anastrozole group,TG levels increased by 17.5% from baseline at 1 year.After 2 years of treatment,TG and LDL-C levels increased by 23.3% and 13.4%,respectively,while HDL-C levels decreased by 19.6%.After 3 years,the TC level increased by 16.8%compared with the baseline level before medication.In Exemestane group,HDL-C level increased 22.4% and 32.6% after 2 and 3 years of treatment,respectively.After3 years of treatment,the level of LDL-C in the Letrozole group was significantly higher than that in the Anastrozole and Exemestane groups.The level of TC in Anastrozole group was significantly higher than that in Letrozole group(P=0.005)and Exemestane group(P=0.002).The level of TG in Exemestane group was significantly lower than that in Anastrozole group and Letrozole group at 1 year and 2years of medication.In addition,the level of HDL-C in Exemestane group was significantly higher than that in Letrozole group and Anastrozole group at 2 years and3 years of medication.Conclusion: After breast cancer surgery,AIs was used for endocrine therapy.Letrozole,Anastrozole and Exemestane had no significant effect on blood lipid during half a year of medication.When the duration of using AIs was extended to 1-3 years,TC,TG,HDL-C and LDL-C were increased to different degrees.In addition,the non-steroidal AIs(Letrozole,Anastrozole)group had a significantly higher probability of elevated blood lipids(TG,TC,LDL-C)than the steroid AI(Exemestane)group,and Exemestane could increase the level of HDL-C,but had no significant effect on TG,TC,LDL-C.It is speculated that steroid AIs has a protective effect on blood lipids in postmenopausal breast cancer patients.