We compared endocrine regimens on subclinical atherosclerosis and 24-month lipid trajectories and explored potential modulatory effects of Sanhuang Decoction (SHD).<h4>Methods</h4>In this retrospective cohort of 280 HR+/HER2- patients, initial endocrine therapy was AI+OFS (n = 95), tamoxifen (TAM; n = 141), or TAM+OFS (n = 44). The gene discussed is HR; the disease is atherosclerosis.