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[Prevention of heart failure]
D Logeart1, C Guiti, P V Ennezat
1Service de cardiologie, hôpital Beaujon, Clichy.
Insights
Preventing heart failure involves managing hypertension and coronary artery disease. Early detection of left ventricular dysfunction and targeted therapies like ACE-inhibitors offer improved outcomes.
Area of Science:
- Cardiology
- Public Health
- Preventive Medicine
Context:
- Heart failure presents a significant public health challenge with poor prognosis in advanced stages.
- Primary prevention strategies focus on managing key etiological factors: hypertension and coronary artery disease.
- Early detection of asymptomatic left ventricular dysfunction can be achieved through echocardiography and neurohormonal markers.
Purpose:
- To outline primary prevention strategies for heart failure.
- To discuss the role of treating etiological factors in preventing heart failure.
- To highlight emerging therapeutic targets for ventricular remodeling and dysfunction.
Summary:
- Prevention of heart failure centers on controlling hypertension and coronary artery disease.
- Coronary recanalization in ischemic heart disease may limit left ventricular remodeling.
- Pharmacological interventions including ACE-inhibitors and beta-blockers are crucial, with angiotensin II-antagonists showing promise.
- Dual blockade of the sympathetic nervous and angiotensin-aldosterone systems is recommended.
- Novel targets include endothelin receptors, apoptosis, oxidative stress, cytokines, and angiogenesis.
Impact:
- Effective primary prevention can reduce the public health burden of heart failure.
- Early intervention in asymptomatic left ventricular dysfunction can prevent disease progression.
- Understanding neurohormonal pathways and molecular targets opens avenues for future preventive treatments.
Abstract:
Heart failure is a major problem of public health, associated with poor outcome in the advanced stage, thus justifying its prevention. Primary prevention is based on the prevention and treatment of its principal etiologic factors, hypertension and coronary artery disease. Broad use of echocardiography or dosage of neurohormonal markers improve detection of asymptomatic left ventricular dysfunction. In ischemic heart disease, coronary recanalisation prevents or limits left ventricular remodeling and dysfunction, even if the "open artery" theory has not been entirely proved. Understanding the deleterous role of neurohormonal stimulation results in a large use of ACE-inhibitors, which beneficial effect has been demonstrated also in case of asymptomatic left ventricular dysfunction. Betablockers, already largely used after myocardial infarction, seem to have also a beneficial effect in heart failure: the same is probably also true for angiotensin II-antagonists. Double blocking of both the sympathetic nervous system and the angiotensin-aldosterone system seems to be recommended. More precisely understanding the pathways signaling the processes of ventricular remodeling and dysfunction points to new potential targets for a preventive treatment: endothelin receptors, apoptosis, oxidative stress, cytokines or even angiogenesis.