What Increases Your Risk of Harm to Your Heart

The rate of cardiotoxicity from HER2-targeted therapy varies according to the agent used, other treatments given and some characteristics unique to the patient. The most important factors that make patients receiving HER2-targeted therapy more likely to experience cardiotoxicity are the following:

• Cancer treatments given at the same time that also can affect the heart, including anthracyclines or radiation.
• Older age. The risk of cardiotoxicity rises with increasing age, especially if you are 60 or older.
• Existing heart disease or risk factors for heart disease.

If you already have some form of heart disease, you are more prone to have heart damage from cardiotoxic medications. For example if you have:

• Heart failure
• Abnormal heart function (low ejection fraction)
• Coronary heart disease
• Atrial fibrillation
• High blood pressure
• High cholesterol
• Diabetes
• Abnormal kidney function
• Obesity (BMI of 30 or greater)

You are at higher risk for cardiotoxicity likely because your heart's ability to tolerate stress is lower. Occasionally, providers may choose not to give HER2-targeted therapies if the risk of heart damage is too great. This might occur for patients with an abnormal heart function or who have heart failure. In these circumstances and for most patients with heart disease, talking to a cardio-oncologist or cardiologist might be recommended.

Patients and providers are encouraged to engage in a discussion about risks and benefits and decide together which is the right treatment plan for you, the patient. In some cases, the HER2-targeted therapies may be given with careful monitoring if the benefits are seen to outweigh the risks. They may also be given with heart medications, which may act to protect the heart from damage.