The effect of antiestrogen agents on risk of autoimmune disorders in patients with breast cancer.

OBJECTIVE: To investigate the relationship between antiestrogen therapy in women with breast cancer and risk of autoimmune disease. METHODS: We used a national database to assess the incidence of systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) following treatment with selective estrogen receptor modulators (SERM) or aromatase inhibitors (AI) in women with breast cancer. The total number of patients in our study was 190,620. RESULTS: We observed highly significant, cumulative dose-dependent increased OR of incidence of both SLE and RA following treatment with SERM (p < 0.0001). The odds of developing RA were also increased following AI therapy (p < 0.001), but there was a trend for reduced odds of SLE, though this trend did not attain statistical significance (p = 0.070 for 2-11 months of treatment and p = 0.254 for 12+ months of treatment). CONCLUSION: Antiestrogen agents may have an important effect on risk of autoimmune disease.

Cardiovascular disease risk awareness in systemic lupus erythematosus patients.

OBJECTIVE: Cardiovascular disease (CVD) is a major cause of morbidity and mortality in systemic lupus erythematosus (SLE) patients. The aim of this study was to identify factors associated with patients' recognition of SLE as an independent risk factor for CVD and their perception of their personal CVD risk. METHODS: SLE patients were sent questionnaires that assessed demographic characteristics, any CVD risk factors, and information regarding the CVD counseling they had received from their physicians. Variables significantly associated with the outcomes were analyzed using logistic regression models. RESULTS: Information obtained from 226 questionnaires was analyzed. Fifty-eight percent of the respondents reported receiving no CVD counseling from a physician. Patients who recalled receiving counseling from a physician were 2.3 times more likely (P = 0.02) to recognize SLE as a CVD risk factor and 3.2 times more likely (P = 0.02) to perceive themselves as being at risk of CVD compared with those patients who did not receive physician counseling. Receiving physician CVD counseling was the strongest predictor of a patient's self-perception of CVD risk. Those patients at intermediate to high risk (n = 167) who reported having received counseling were 5.3 times as likely (P = 0.007) to perceive themselves to be at higher risk of CVD compared with similar patients who did not receive counseling. Younger patients were 4.2 times as likely (P = 0.002) as older patients to recognize SLE as a CVD risk factor. Other variables associated with patients' self-perceptions of CVD risk included family history of CVD and hypertension. CONCLUSION: Physician counseling regarding CVD in SLE patients has an important impact on patients' awareness of SLE as a CVD risk factor and their self-perception of CVD risk.