SynthesisAnnals of oncology : official journal of the European Society for Medical Oncology2017
Cardiotoxicity of aromatase inhibitors and tamoxifen in postmenopausal women with breast cancer: a systematic review and meta-analysis of randomized controlled trials.
Synthesis in Annals of oncology : official journal of the European Society for Medical Oncology, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04337736 (The Impact of Different Physical Exercise Protocols on Cardio-vascular Efficiency and Quality of Life in Breast Cancer Survivors), which is not on this map. Cited by 94 papers, 6 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
The Impact of Different Physical Exercise Protocols on Cardio-vascular Efficiency and Quality of Life in Breast Cancer Survivors
Who cites it
94 citing papers in PubMed, 6 syntheses or guidelines pooled it, 208 citations in OpenAlex.
- Aromatase enzyme: Paving the way for exploring aromatization for cardio-renal protection.Biomedicine & pharmacotherapy = Biomedecine & pharmacotherapie · 2023Pooled it
- Risk of Cardiovascular Events and Lipid Profile Change in Patients with Breast Cancer Taking Aromatase Inhibitor: A Systematic Review and Meta-Analysis.Current oncology (Toronto, Ont.) · 2023Pooled it
- Aromatase inhibitors and risk of cardiovascular events in breast cancer patients: a systematic review and meta-analysis.BMC pharmacology & toxicology · 2019Pooled it
- Long term adjuvant endocrine therapy and risk of cardiovascular disease in female breast cancer survivors: systematic review.BMJ (Clinical research ed.) · 2018Pooled it
- Cardiovascular Disease and Breast Cancer: Where These Entities Intersect: A Scientific Statement From the American Heart Association.Circulation · 2018Pooled it
- Association Between Aromatase Inhibitors and Myocardial Infarction Morbidity in Women With Breast Cancer: A Meta-Analysis of Observational Studies.Cancer control : journal of the Moffitt Cancer CenterPooled it
- Time-Dependent Association Between Breast Cancer and Risk of Ischemic Stroke: A Nationwide Cohort Study.Neurology · 2026Article
- Cardiovascular Disease in Males With Breast Cancer: A Population-Based Cohort Study.JACC. Advances · 2026Article
- Endocrine therapy and COVID-19 outcomes in women with breast cancer: a nationwide register- based matched cohort study.BMC cancer · 2026Article
- Metabolic Syndrome Is Associated with Increased Plasma Fibroblast Growth Factor 21 (FGF21) in Postmenopausal Breast Cancer Survivors: Implications for Therapy and Diagnosis.Pathophysiology : the official journal of the International Society for Pathophysiology · 2026Article
- Assessing Research Impact With Bibliometrics and Altmetrics: The Case of the Canadian Network for Observational Drug Effect Studies (CNODES).Pharmacoepidemiology and drug safety · 2026Article
- Protective Effects of Hesperidin on Letrozole-Induced Neurotoxicity: Involvement of Oxidative Stress, Apoptotic Signaling, and Inflammation.Journal of biochemical and molecular toxicology · 2026Article
- Vascular Toxicities of Cancer Therapies: 2025 Update.Arteriosclerosis, thrombosis, and vascular biology · 2026Review
- Cholesterol Metabolism in Cancer Patients: Mechanisms, Treatment-Related Effects, and Cardio-Oncology Management.Oncology research · 2026Review
- Cardiovascular Risks of Aromatase Inhibitors versus Tamoxifen in Postmenopausal Breast Cancer: A Multinational Cohort Study.Clinical epidemiology · 2026Article
- Impact of adjuvant endocrine therapy utilization in male patients with early breast cancer: results from a large German real-world claims data analysis.Archives of gynecology and obstetrics · 2025Article
- Rationale and design of the IMProving Adherence to medications for breast Cancer and cardiovascular disease equiTably (IMPACT) randomized clinical trial.Contemporary clinical trials · 2025Article
- Risk of atherosclerotic cardiovascular disease after cancer diagnosis: findings from 3 prospective cohort studies.Journal of the National Cancer Institute · 2025Article
- Review
- Endocrine therapy and risk of cardiovascular disease and mortality in postmenopausal breast cancer survivors.Journal of the National Cancer Institute · 2025Article
34 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: Aromatase inhibitors (AIs) have been associated with cardiovascular disease in adjuvant randomized controlled trials (RCTs) comparing these drugs to tamoxifen. However, it is unclear whether this risk is real or due to cardioprotective effects of tamoxifen. To address this question, we conducted a systematic review and meta-analysis of all RCTs of AIs and tamoxifen in adjuvant and extended adjuvant setting. Patients and methods: We searched PubMed, Embase (OVID), Cochrane CENTRAL, WHO International Clinical Trials Registry Platform, and ClinicalTrials.gov from inception to June 2016 for all RCTs comparing cardiovascular and cerebrovascular safety of AIs to tamoxifen, AIs to placebo or no-treatment, or tamoxifen to placebo or no-treatment in the adjuvant or extended adjuvant setting. Relative risks (RRs) were pooled using DerSimonian and Laird random-effects models with analyses stratified by RCT design. Results: A total of 19 RCTs were included in the meta-analysis (n = 62 345). In the adjuvant setting, AIs were associated with a 19% (RR: 1.19, 95% confidence interval [CI]: 1.07-1.34) increased risk of cardiovascular events compared with tamoxifen. AIs were not associated with an increased risk compared with placebo in the extended-adjuvant setting (RR: 1.01, 95% CI: 0.85-1.20). In the adjuvant setting, tamoxifen was associated with a 33% (RR: 0.67, 95% CI: 0.45-0.98) decreased risk compared with placebo or no-treatment. The results from extended adjuvant RCTs comparing tamoxifen to placebo were inconclusive but suggestive of a small protective effect (RR: 0.91, 95% CI: 0.77-1.07). Conclusions: The increased risk of cardiovascular events with AIs relative to tamoxifen is likely the result of cardioprotective effects of the latter. This new evidence should be considered when assessing the benefits and risks of AIs in the treatment of breast cancer.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.