Prevention

You can take several steps to help lower your risk of developing heart damage during treatment with cardiotoxic medications.

Be Heart-Healthy

Anything you can do to keep your heart as healthy as possible will reduce your risk of cardiotoxicity. Studies suggest that people who are overweight or obese are at increased risk of developing heart damage during cancer treatment. Similarly, data show that most patients decrease their levels of physical activity and gain weight after being diagnosed with cancer, both of which are associated with higher risk of heart disease. To find out whether you are above your ideal weight, calculate your body mass index (BMI). A BMI between 25 and 29.9 indicates you are overweight, and BMI of 30 or greater means that you have obesity.

If you are overweight or obese, try to lose weight. Try to eat a heart-healthy diet that is low in salt and saturated fats and rich in whole grains, fruits and vegetables. The DASH diet is a good one to try.

Similarly, it is important to stay active. Current guidelines recommend engaging in no less than 75 minutes per week of intense exercise or 150 minutes per week of moderate or intense exercise. But any physical activity is better than nothing.

Smoking increases the risk of heart attacks and heart damage. If you smoke, work with your provider on strategies to quit. If you don't smoke, don't start!

Know Your Numbers!

Most studies suggest that having an elevated blood pressure, diabetes or high cholesterol increases the risk of cardiotoxicity. These also are risk factors for heart disease and put stress on your heart. The more stress on your heart, the higher your chance of developing heart damage. Follow up with either your primary care provider or cardiologist to ensure these conditions are well controlled.

What if You Have Heart Disease

If you have a history of poor heart function (low ejection fraction), heart failure, coronary artery disease (if you had a heart attack or received a stent), or an abnormal heart rhythm, you should see a cardiologist or cardio-oncologist to manage these conditions.

A few studies have suggested certain medications may help prevent cardiotoxicity from HER2-targeted therapies. These include angiotensin converting enzyme inhibitors (ACE inhibitors), angiotensin receptor blockers (ARBs) and beta blockers. Most providers will not routinely start these medications for this purpose if there is no history of heart disease or heart risk factors. More research is needed and currently in progress.

However, if you already have heart disease, you may benefit from being on one or more of these medicines when you receive HER2-targeted therapy.