Effect of antiestrogen regimen on prostacyclin and thromboxane A2 in postmenopausal patients with breast cancer: Evidence of significance of hypertension, smoking or previous use of estrogen therapy

To explore the mechanism(s) by which antiestrogens may protect against the development of cardiovascular disorders, we measured the production of vasodilatory, antiaggregatory prostacyclin (PGI₂ and that of vasoconstrictive, proaggregatory thromboxane A₂ (TxA₂) before and after 6 months' use of antiestrogens in postmenopausal patients after operation for stage II breast cancer (n = 38). Urine samples were assayed by high performance liquid chromatography and radioimmunoassays for 2,3-dinor-6-ketoprostaglandin F1α (=metabolite of PGI₂, dinor-6-keto) and for 2,3-dinor-thromboxane B₂ (=metabolite of TxA₂, dinor-TxB₂). In addition, in 35 of these 38 patients we assayed the capacity of platelets to produce thromboxane A2 during standardized blood clotting. The 4 patients using low-dose aspirin had low thromboxane production, and were excluded from further analysis of the data. An antiestrogen regimen consisting either of tamoxifen (n = 15) or of toremifene (n = 19) caused no changes in production of PGI₂ or TxA₂, or in their ratio, and in this regard, these antiestrogens behaved similarly. Hypertensive patients (n = 7) using different antihypertensive agents were characterized by reduced urinary out-put of dinor-6-keto (18.5 ± 6.1 vs 35.5 ± 18.5 ng/mmol, mean ± SD, p < 0.05) and reduced platelet capacity to produce TxA₂ (62.6 ± 67.8 vs 134.6 ± 75.6 ng/mL, p < 0.05). The patients (n = 15) who had used estrogen replacement therapy (ERT) up until diagnosis of breast cancer showed reduced dinor-TxB₂ excretion (15.5 ± 12.7 vs 29.9 ± 20.9 ng/mmol, p < 0.05) before initiation of antiestrogens, and elevated dinor-6-keto output during the antiestrogen regimen (32.4 ± 21.2 vs 22.7 ± 8.7 ng/mmol, p = 0.07). Smokers (n = 6) had elevated dinor-TxB2 output before and during antiestrogen use. Thus we conclude that the cardiovascular protection provided by an antiestrogen regimen is unlikely to be mediated through vaso- and platelet active PGI₂ and TxA₂.