Breast Cancer Research and Treatment

, Volume 138, Issue 2, pp 467–473 | Cite as

Effects of adjuvant tamoxifen therapy on cardiac disease: results from a randomized trial with long-term follow-up

  • Johan RosellEmail author
  • Bo Nordenskjöld
  • Nils-Olof Bengtsson
  • Tommy Fornander
  • Thomas Hatschek
  • Henrik Lindman
  • Per-Olof Malmström
  • Arne Wallgren
  • Olle Stål
  • John Carstensen
Clinical Trial


Tamoxifen is associated with a reduced risk of coronary heart disease (CHD). However, there are few reports on long-term effects. Using data from a large Swedish randomized trial of 5 and 2 years of adjuvant tamoxifen in women with early breast cancer, we here present results on morbidity and mortality from cardiac diseases during treatment and long-term after treatment. A total of 4,150 patients were breast cancer recurrence-free after 2 years. Data from the Swedish National Hospital Discharge Registry combined with information from the Swedish Cause of Death Registry were used to define events of disease. Hazard ratios were estimated using Cox regression. Patients assigned to 5 years in comparison with 2 years of postoperative tamoxifen experienced a reduced incidence of CHD [hazard ratio (HR), 0.83; 95 % CI 0.70–1.00], especially apparent during the active treatment period (HR 0.65; 95 % CI 0.43–1.00). The mortality from CHD was significantly reduced (HR 0.72; 95 % CI 0.53–0.97). During the active treatment, the morbidity of other heart diseases was also significantly reduced (HR 0.40; 95 % CI 0.25–0.64) but not after treatment stopped (HR 1.06; 95 % CI 0.87–1.30). Similar results were seen for both heart failure and atrial fibrillation/flutter. As compared to 2 years of therapy, 5 years of postoperative tamoxifen therapy prevents CHD as well as other heart diseases. The risk reduction is most apparent during the active treatment period, and later tends to diminish.


Breast cancer Tamoxifen Adjuvant treatment Adverse events Heart failure Coronary heart disease 


Conflict of interest

The authors have no financial disclosures to declare.


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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Johan Rosell
    • 1
    • 2
    Email author
  • Bo Nordenskjöld
    • 2
  • Nils-Olof Bengtsson
    • 3
  • Tommy Fornander
    • 4
  • Thomas Hatschek
    • 4
  • Henrik Lindman
    • 5
  • Per-Olof Malmström
    • 6
  • Arne Wallgren
    • 7
  • Olle Stål
    • 2
  • John Carstensen
    • 8
  1. 1.Regional Cancer Centre, County Council of Östergötland, University HospitalLinköpingSweden
  2. 2.Oncology, Department of Clinical and Experimental Medicine, Faculty of Health SciencesLinköping University, County Council of ÖstergötlandLinköpingSweden
  3. 3.Department of OncologyUmeå University HospitalUmeåSweden
  4. 4.Department of OncologyKarolinska University HospitalStockholmSweden
  5. 5.Department of OncologyUppsala University HospitalUppsalaSweden
  6. 6.Skånes Department of OncologySkåne University HospitalLundSweden
  7. 7.Department of OncologySahlgrenska University HospitalGöteborgSweden
  8. 8.Department of Health and SocietyLinköping UniversityLinköpingSweden

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