Retrospective analysis identifies risk factors for trastuzumab-induced cardiotoxicity in HER2-positive breast cancer patients

To analyze the risk factors for cardiotoxicity induced by trastuzumab in human epidermal growth factor receptor 2 (HER2) -positive breast cancer patients and provide a basis for early clinical intervention. A retrospective analysis was conducted on 298 HER2-positive breast cancer patients treated with trastuzumab. Clinical data including age, history of cardiovascular disease, combined chemotherapy regimens, N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, and baseline left ventricular ejection fraction (LVEF) were collected. Multivariate logistic regression was used to identify independent risk factors for cardiotoxicity. A total of 65 patients (21.8%) developed cardiotoxicity. Multivariate analysis showed that age ≥60 years (OR = 1.97, 95%CI: 1.21–3.22), history of hypertension (OR = 2.10, 95%CI: 1.24–3.56), combined anthracycline therapy (OR = 3.06, 95%CI: 1.67–5.62), baseline NT-proBNP ≥200 pg/ml (OR = 2.34, 95%CI: 1.35–4.05), and baseline LVEF ≤55% (OR = 2.51, 95%CI: 1.42–4.43) were independent risk factors for trastuzumab-induced cardiotoxicity (all P < 0.05). These findings enable risk stratification before trastuzumab initiation. Future research should validate a predictive model incorporating these factors and assess cardioprotective strategies, thereby translating risk assessment into actionable protocols to optimize cardiac safety without compromising oncologic outcomes.