Endocrine therapy adherence and 10-year cardiometabolic risk in hormone receptor-positive breast cancer
Abstract
Background: Adjuvant endocrine therapy (AET) reduces breast cancer (BC) recurrence but may adversely affect cardiometabolic health. We evaluated the association between AET adherence duration and 10-year risk of hypertension, dyslipidemia, diabetes, and mortality among postmenopausal women with early-stage hormone receptor-positive BC.
Methods: We conducted a prospective cohort study of 8365 postmenopausal women with stage I-III hormone receptor-positive BC within Kaiser Permanente Northern California who initiated AET between 2005 and 2013. Adherence (proportion of days covered >80%) was assessed annually using prescription dispensing data. We estimated 10-year cumulative incidence (CI) under 6 adherence duration strategies (0-5 years) using sequentially doubly robust estimation, adjusting for demographic, clinical, lifestyle, and tumor characteristics. Analyses were stratified by AET type (aromatase inhibitor [AI]; tamoxifen [TAM]).
Results: Overall, 42.7% were adherent for ≥5 years. Compared with nonadherence, 5-year adherence was associated with higher 10-year CI of hypertension (absolute CI difference = 8.81% [95% confidence interval: 4.25 to 13.4]), dyslipidemia (5.16% [0.31 to 10.0]), and diabetes (2.58% [0.02 to 5.14]) but lower all-cause death (10.7% [7.74 to 13.7]) and BC-specific death (5.37% [3.36 to 7.38]). Five-year AI adherence was associated with increased hypertension (9.37% [4.54 to 14.2]), dyslipidemia (6.84% [1.76 to 11.9]), and diabetes (3.29% [0.58 to 6.00]), whereas TAM adherence was associated only with hypertension (9.37% [4.54 to 14.2]). AI adherence was associated with higher dyslipidemia risk than TAM (9.86% [5.09 to 14.6]).
Conclusions: AI adherence was associated with increased cardiometabolic risk, whereas TAM was associated only with hypertension risk. Despite these risks, AET was associated with improved survival. Further research should evaluate whether cardiometabolic risk factors influence cardiovascular events among BC survivors.
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BibTeX
@article{ledesma2026endocrine,
title = {{Endocrine therapy adherence and 10-year cardiometabolic risk in hormone receptor-positive breast cancer}},
author = {Jorge R Ledesma and Joshua Nugent and Richard Cheng and Jennifer M Specht and Cecile A Laurent and Janise Roh and Sayan Dasgupta and Allison Meisner and Samir R Thadani and Heather Greenlee and Raymond Liu and Marilyn L Kwan},
journal = {JNCI Cancer Spectrum},
year = {2026},
month = sep,
doi = {10.1093/jncics/pkag095},
url = {https://doi.org/10.1093/jncics/pkag095},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Endocrine therapy adherence and 10-year cardiometabolic risk in hormone receptor-positive breast cancer
AU - Jorge R Ledesma
AU - Joshua Nugent
AU - Richard Cheng
AU - Jennifer M Specht
AU - Cecile A Laurent
AU - Janise Roh
AU - Sayan Dasgupta
AU - Allison Meisner
AU - Samir R Thadani
AU - Heather Greenlee
AU - Raymond Liu
AU - Marilyn L Kwan
PY - 2026
DA - 2026/09/24
JO - JNCI Cancer Spectrum
DO - 10.1093/jncics/pkag095
UR - https://doi.org/10.1093/jncics/pkag095
AB - Background: Adjuvant endocrine therapy (AET) reduces breast cancer (BC) recurrence but may adversely affect cardiometabolic health. We evaluated the association between AET adherence duration and 10-year risk of hypertension, dyslipidemia, diabetes, and mortality among postmenopausal women with early-stage hormone receptor-positive BC. Methods: We conducted a prospective cohort study of 8365 postmenopausal women with stage I-III hormone receptor-positive BC within Kaiser Permanente Northern California who initiated AET between 2005 and 2013. Adherence (proportion of days covered >80%) was assessed annually using prescription dispensing data. We estimated 10-year cumulative incidence (CI) under 6 adherence duration strategies (0-5 years) using sequentially doubly robust estimation, adjusting for demographic, clinical, lifestyle, and tumor characteristics. Analyses were stratified by AET type (aromatase inhibitor [AI]; tamoxifen [TAM]). Results: Overall, 42.7% were adherent for ≥5 years. Compared with nonadherence, 5-year adherence was associated with higher 10-year CI of hypertension (absolute CI difference = 8.81% [95% confidence interval: 4.25 to 13.4]), dyslipidemia (5.16% [0.31 to 10.0]), and diabetes (2.58% [0.02 to 5.14]) but lower all-cause death (10.7% [7.74 to 13.7]) and BC-specific death (5.37% [3.36 to 7.38]). Five-year AI adherence was associated with increased hypertension (9.37% [4.54 to 14.2]), dyslipidemia (6.84% [1.76 to 11.9]), and diabetes (3.29% [0.58 to 6.00]), whereas TAM adherence was associated only with hypertension (9.37% [4.54 to 14.2]). AI adherence was associated with higher dyslipidemia risk than TAM (9.86% [5.09 to 14.6]). Conclusions: AI adherence was associated with increased cardiometabolic risk, whereas TAM was associated only with hypertension risk. Despite these risks, AET was associated with improved survival. Further research should evaluate whether cardiometabolic risk factors influence cardiovascular events among BC survivors.
SN - 2515-5091
ER -