Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jul 1;117(7):1401-1409.
doi: 10.1093/jnci/djaf063.

Endocrine therapy and risk of cardiovascular disease and mortality in postmenopausal breast cancer survivors

Yuhan Huang  1   2 , Marilyn L Kwan  3 , Susan R Heckbert  1 , Nicholas L Smith  1   4   5 , Megan Othus  1   2 , Cecile A Laurent  3 , Janise M Roh  3 , Eileen Rillamas-Sun  2 , Valerie S Lee  3 , Tatjana Kolevska  6 , Richard K Cheng  7 , Carlos Irribarren  3 , Mai Nguyen-Huynh  3   8 , Dawn L Hershman  9 , Lawrence H Kushi  3 , Heather Greenlee  2   3   7
Affiliations

Endocrine therapy and risk of cardiovascular disease and mortality in postmenopausal breast cancer survivors

Yuhan Huang et al. J Natl Cancer Inst. .

Abstract

Background: There are increasing concerns of cardiovascular safety related to endocrine therapy use in women with breast cancer (BC). We examined risk of cardiovascular disease (CVD) events and mortality associated with endocrine therapy use in postmenopausal women with early-stage BC.

Methods: Postmenopausal women diagnosed with stage I-III hormone receptor-positive BC from 2005 to 2013 were included (n = 8495). Women were classified as aromatase inhibitor (AI) users, tamoxifen users, and non-users of endocrine therapy in the 12 months after BC diagnosis. Likelihood ratio tests examined whether the association of endocrine therapy use with CVD and mortality outcomes varied by body mass index (BMI) and history of CVD before BC diagnosis.

Results: Over a median follow-up of 7.5 years, women who used AIs were less likely to develop major adverse cardiovascular events (MACE) (HR = 0.84, 95% CI = 0.73 to 0.97) and heart failure (HR = 0.81, 95% CI = 0.66 to 0.99) compared with non-users of endocrine therapy. No associations between tamoxifen use and CVD outcomes were observed. AI use was associated with lower risk all-cause, CVD-related, and non-CVD-related mortality, compared with non-use of endocrine therapy. Tamoxifen use was associated with lower risk of all-cause mortality and non-CVD-related mortality, compared with non-use of endocrine therapy, and the association was modified by BMI (P for interaction < .05).

Conclusion: Our findings suggest endocrine therapy use reduces all-cause mortality risk and may not increase CVD risk in postmenopausal women with early-stage hormone receptor-positive BC.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: None

Figures

Figure 1:
Figure 1:
STROBE diagram of study population
Figure 2:
Figure 2:
The ascertainment of endocrine therapy use
See this image and copyright information in PMC

References

    1. Howlader N, Noone A, Krapcho M, et al. SEER cancer statistics review, 1975–2018. National Cancer Institute; 2021.
    1. Schairer C, Mink PJ, Carroll L, et al. Probabilities of death from breast cancer and other causes among female breast cancer patients. J Natl Cancer Inst 2004;96(17):1311–21. - PubMed
    1. Mehta LS, Watson KE, Barac A, et al. Cardiovascular Disease and Breast Cancer: Where These Entities Intersect: A Scientific Statement From the American Heart Association. Circulation 2018;137(8):e30–e66. - PMC - PubMed
    1. Ramin C, Schaeffer ML, Zheng Z, et al. All-Cause and Cardiovascular Disease Mortality Among Breast Cancer Survivors in CLUE II, a Long-Standing Community-Based Cohort. J Natl Cancer Inst 2021;113(2):137–145. - PMC - PubMed
    1. Armenian SH, Xu L, Ky B, et al. Cardiovascular Disease Among Survivors of Adult-Onset Cancer: A Community-Based Retrospective Cohort Study. J Clin Oncol 2016;34(10):1122–30. - PMC - PubMed

MeSH terms