Figure 1.

A schematic representation describing the “multiple‐hit” hypothesis. At diagnosis, a significant proportion of early breast cancer patients present with preexisting or heightened cardiovascular disease (CVD) risk factors, which increase the risk of adjuvant therapy–associated cardiovascular injury. Independently, many adjuvant therapies used in breast cancer are associated with unique and varying degrees of direct adverse effects on the cardiovascular system. These direct effects occur in the context of concomitant lifestyle perturbations (indirect effects) that combine to reduce cardiovascular reserve. Collectively, these changes may leave the patient more susceptible to further cardiovascular insults and at higher risk of premature death due to cardiovascular mortality. From: Jones et al.,9 with permission