Practice Cases
SERMs in Osteoporosis: Question Five
Your answer is incorrect. The correct answer is C.
Your patient returns after several months. She initially experienced mild hot flashes but these have decreased, and she is tolerating raloxifene well. She wants to know if it will effect her cholesterol level or cause heart disease. Which statement about raloxifene's effects on lipids and coronary heart disease (CHD) is most accurate?
- Option A Increases both LDL and risk of CHD
- Option B Decreases LDL, HDL, and CHD
- Option C Decreases LDL with no effect on CHD
- Option D Decreases triglycerides and increases HDL with no effect on CHD
How does raloxifene affect lipids and coronary heart disease (CHD)?
Raloxifene is associated with a decrease in total cholesterol and LDL. It does not have any effect on triglycerides, HDL, or coronary heart disease (CHD).
Randomized trials of raloxifene's use in postmenopausal women have consistently demonstrated a 10 percent to 15 percent reduction in serum low-density lipoprotein levels (1). This effect is similar in magnitude to the reduction seen with estrogen supplementation. Raloxifene has no apparent effect on total serum high-density lipoprotein levels or triglycerides.
The RUTH (Raloxifene Use for The Heart) trial, specifically designed to assess the effect of raloxifene on coronary events, did not show any difference in coronary events between women taking placebo and those on raloxifene (2). This randomized trial included greater than 10,000 postmenopausal women with CHD or multiple risk factors for CHD who were followed for 5-6 years.
Tamoxifen has similar lipid effects and data from the Study of Tamoxifen and Raloxifene (STAR) P-2 trial did not find any differences in ischemic heart disease events or stroke between the two treatments (4). This was a large prospective, double blind, randomized trial of over 19,000 postmenopausal women at increased risk of breast cancer.
- Clemett D, Spencer CM. Raloxifene: A review of its use in postmenopausal osteoporosis. Drugs 2000; 60: 379-411.
- Barrett-Connor E, Mosca L, Collins P, et al., for the Raloxifene Use for The Heart (RUTH) Trial Investigators.. Effects of raloxifene on cardiovascular events and breast cancer in postmenopausal women. N Engl J Med 2006; 355: 125-137.
- Vogel VG, Costantino JP, Wickerham DL, Cronin WM, Cecchini RS, et al. for the National Surgical Adjuvant Breast and Bowel Project (NSABP). Effects of tamoxifen vs raloxifene on the risk of developing invasive breast cancer and other disease outcomes. The NSABP Study of Tamoxifen and raloxifene (STAR) P-2 Trial. JAMA 2006; 295: 2727-2741.