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(Circulation. 2002;106:2925.)
© 2002 American Heart Association, Inc.

Clinical Investigation and Reports

Influence of Tamoxifen on Carotid Intima-Media Thickness in Postmenopausal Women

T. Simon, MD, PhD; P. Boutouyrie, MD, PhD; J.M. Simon, MD; B. Laloux, PhD; C. Tournigand, MD; A.I. Tropeano, MD; S. Laurent, MD, PhD; P. Jaillon, MD

From the Departments of Pharmacology (T.S., P.J.) and Oncology (C.T.), St Antoine University-Hospital; the Department of Pharmacology and INSERM EMI-0107, Georges-Pompidou University-Hospital (P.B., B.L., A.I.T., S.L.); and the Department of Oncology and Radiotherapy, Pitié-Salpétrière University-Hospital, Assistance Publique-Hôpitaux de Paris and Paris-VI University (J.M.S.), Paris, France.

Correspondence to T. Simon, Department of Pharmacology, CHU St Antoine, 27, Rue Chaligny, 75012, Paris, France. E-mail tabassome.simon{at}chusa.jussieu.fr

Background— Intima-media thickness of the common carotid artery (IMT-CCA) is an early marker of atherosclerosis. Tamoxifen is a selective estrogen-receptor modulator with estrogen-like effects on cardiovascular risk factors but as-yet unexplored effects on carotid artery structure. The goal of this study was to determine the influence of tamoxifen on IMT-CCA in menopausal women.

Methods and Results— With a predefined calculation of the sample size, 67 menopausal women with cancer who were treated with tamoxifen for 1 year and 37 menopausal women with cancer who were never treated with tamoxifen were enrolled. IMT-CCA, internal diameter, and pulse pressure were determined with a high-definition echotracking device and applanation tonometry in a central core laboratory that was blinded to treatment. Both groups were similar for clinical characteristics, including cardiovascular risk factors. IMT and internal diameter were significantly lower in the tamoxifen group (mean duration of treatment, 2.4±0.9 years) than in the control group (609±117 µm versus 662±147 µm, P=0.04, and 4.89±0.60 mm versus 5.12±0.58 mm, P=0.03, respectively). Pulse pressure was not influenced by the use of tamoxifen. After adjustment for age, cardiovascular risk factors, carotid pulse pressure, duration of menopause, and previous use of hormone replacement therapy, IMT remained significantly lower among tamoxifen users (P<0.00001), with an impact on IMT (-70 µm) equivalent to spontaneous evolution with 12 years of aging (5 µm/y).

Conclusion— The use of tamoxifen was associated with a significantly lower carotid IMT in menopausal women with cancer. Randomized trials are needed to confirm the cardioprotective effect of selective estrogen-receptor modulators in terms of prevention of atherosclerosis.

Key Words: selective estrogen receptor modulators • atherosclerosis • carotid arteries • prevention • menopause

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