J Menopausal Med.  2021 Dec;27(3):s3.

Serum cholesterol changes by duration of GnRH-agonist therapy in premenopausal women with breast cancer

• Choi SW
• Kim JH
• Lee SR
• Kim SH
• Chae HD

Abstract

Objectives
Ovarian suppression using Gonadotropin releasing hormone (GnRH)-agonist in premenopausal women with breast cancer has been known to improve disease-free survival and overall survival. However, long-term effect of ovarian suppression on lipid metabolism has not been studied yet. In this retrospective cohort study, we aimed to investigate cholesterol changes during medical ovarian suppression.
Methods
and Materials: We reviewed medical records and blood test results of 152 women who have been diagnosed as breast cancer and started GnRH-agonist every 12 weeks therapy for more than 24 weeks in Asan Medical Center between 2018.1.1 and 2020.12.31. Patients who had previously diagnosed dyslipidemia or diabetes, or newly received lipid-lowering agents during study period were excluded from the cohort. Age at diagnosis and preoperative Body Mass Index (BMI) were investigated as baseline demographics. Generalized additive mixed model was applied to analyze the relationship between duration of GnRH-agonist and cholesterol changes.
Results
The age was distributed as 42.5±5.2 years old (mean±SD), and preoperative BMI was 23.0±3.6 kg/m² (mean±SD). Duration of GnRH agonist therapy ranged from 5.6 to 37.7 months, with mean of 19.3. Total cholesterol was 171 mg/dL before starting GnRH-agonist, whereas 181 mg/dL on last check, which was significantly higher than initial value (p=0.03). Duration of GnRH-agonist did not affect total cholesterol level until 19.3 months, while significantly increased by 1.8 mg/dL for each month thereafter (p=0.011). There was no significant effect of age, preoperative BMI and GFR on total cholesterol.
Conclusion
While long-term use of GnRH-agonist is applied, patients should be monitored for dyslipidemia after 19 months of treatment and lipid-lowering agents may be considered especially when indicated.