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Cardiovascular risks associated with adjuvant endocrine therapy in women with breast cancer: a population-based cohort study

Cheang I, Gue Y, Wu MZ, Huang JY, Ren QW, Chen Z, Tse YK, Li HL et al.

BMC cancer, 2025

6,577 participants · 5 citations

Abstract

Background: Endocrine therapies, including tamoxifen (TMX) and aromatase inhibitors (AIs), are widely used in breast cancer treatment. This study aims to evaluate the cardiovascular risks associated with these therapies in different age groups of non-metastatic breast cancer patients.

Methods: We conducted a cohort study using data from patients newly diagnosed with non-metastatic breast cancer. Patients were categorized into two ages ( 55 years) and then divided into groups based on whether they were newly receiving either TMX or AI. Follow-up continued until the first occurrence of a study outcome, death, or the last date of data collection (December 31, 2022). Primary outcomes were coronary artery disease, myocardial infarction (MI), ischemic stroke, hospitalization for heart failure (HHF), atrial fibrillation (AF), cardiovascular mortality, all-cause mortality, and major adverse cardiovascular events (MACE).

Results: Among patients 55 years old, 11,846 were newly treated with TMX (n = 6577) or AI (n = 5269). During a median follow-up of 5.0 years, AI users had a significantly increased risk of primary cardiovascular outcomes, including CAD, MI, ischemic stroke, HHF, AF, cardiovascular mortality, and MACE (all P < 0.01).

Conclusion: The study indicates that AIs are linked to a higher risk of cardiovascular events in post-menopausal patients compared to TMX. In younger patients, TMX's protective effect on cardiovascular outcomes may be less pronounced. Further large-scale…

How strong is the evidence?

Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 6,577 participants or records.

How the five levels of evidence work. The level is assigned automatically from the abstract and can be wrong, so check the paper.

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