Do you discontinue an aromatase inhibitor in a patient if they have a cardiac event while on the drug?

Randomized clinical trials and several meta-analyses that compared tamoxifen with aromatase inhibitors (Khosrow-Khavar et al., PMID 32065766 is a more recent one) demonstrated statistically significant increase in the rate of cardiovascular events in women taking aromatase inhibitors although the absolute differences were very small, and number needed to harm was around 160-180 women (Cuppone et al., PMID 18041059). On the other hand, the risk of venous thromboembolic events is higher in patients taking tamoxifen as compared to aromatase inhibitors. When a patient experiences a cardiovascular event while taking an aromatase inhibitor, I typically seek guidance from our cardio-oncology colleagues and want to make sure that cardiac medication...

The decision to continue or discontinue endocrine therapy in a patient with breast cancer needs to take into account the dynamic interplay with other comorbidities and competing causes of mortality.

It’s not so much whether an AI is contributing to the cardiac event, which is less likely in real-time. It is whether the balance of benefit-risk justifies continuing treatment.

As an example, if a patient with DCIS or node negative breast cancer develops a debilitating stroke or heart failure from an MI, then it makes little sense to continue an AI.

Clinical judgement and weighing breast cancer specific survival vs overall survival is the key.