预防心力衰竭:证据生成,试验设计和监管途径
Javed Butler1, Muhammad Shahzeb Khan2, João Pedro Ferreira3
1Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA; Baylor Scott and White Research Institute, Dallas, Texas, USA.
Journal of the American College of Cardiology
|February 11, 2026
概括
预防心力衰竭 (HF) 是至关重要的,因为目前的策略不足以解决四分之一的终身风险. 除了传统的心血管疾病预防之外,还需要新的方法来解决各种HF原因.
科学领域:
- 心脏病学 心脏病学
- 公共卫生 公共卫生
- 预防医学 预防医学
背景情况:
- 心力衰竭 (HF) 造成了严重的公共卫生负担,导致高发病率,死亡率和经济成本.
- 成年人口中相当一部分 (在美国为三分之二) 处于HF前阶段 (A或B阶段).
- 现有疗法改善了HF诊断后的结果,但未能充分降低死亡率和发病率,凸显了初级HF预防的必要性.
研究的目的:
- 解决定义和预防发生心力衰竭的挑战.
- 重新评估除了动脉样硬化心血管疾病之外的预防策略.
- 总结当前和正在进行的HF预防试验,并确定未来的研究优先事项.
主要方法:
- 关于高频率的定义和预防策略的当前文献的综述.
- 对临床试验设计,持续时间和预防HF监管途径的挑战进行分析.
- 来自正在进行和已完成的HF预防试验的综合数据.
主要成果:
- 目前没有专门批准用于初级HF预防的治疗剂.
- 定义和裁决事件HF是复杂的,大多数试验依赖住院数据,忽视门诊诊断.
- 高血压发生于动脉样硬化以外的各种原因,包括肥胖,高血压和癌症疗法.
结论:
- 需要对HF预防策略进行根本性的重新评估,不仅仅是针对冠状动脉疾病的方法.
- 未来的预防工作必须考虑更广泛的HF病因,并纳入门诊诊断设置.
- 解决证据缺口和完善监管途径对于推进初级HF预防至关重要.
相关概念视频
01:29Heart Failure II: Pathophysiology
1.0K
Systolic Heart Failure and Compensatory MechanismsSystolic heart failure (also termed HFrEF, Heart Failure with Reduced Ejection Fraction) is the most prevalent type of heart filure. It results in a decreased volume of blood being pumped from the ventricle. The aortic arch and carotid sinuses have baroreceptors that detect reduced blood pressure, triggering the sympathetic nervous system (SNS) to release epinephrine and norepinephrine. Initially, this response aims to boost heart rate and...
1.0K
02:55The Evidence for Evolution
48.4K
Genetic variations accumulating within populations over generations give rise to biological evolution. Evolutionary changes can result in the formation of novel varieties and entire new species. These changes are responsible for the diverse forms of life inhabiting the planet. The evidence for evolution suggests that all living organisms descended from common ancestors.
48.4K
01:17Pathophysiology of Heart Failure
4.0K
Heart failure (HF) is a progressive syndrome involving ventricles that leads to inadequate cardiac output. It can be classified based on location and output or ejection fraction. Ejection fraction (EF) is an essential measurement in the diagnosis and surveillance of HF. Reduced EF corresponds to systolic heart failure (HFrEF). However, HF with preserved ejection fraction (HFpEF) is becoming increasingly prevalent. Also known as diastolic HF, this form of HF is related to aging. The...
4.0K
01:27Heart Failure I: Introduction
951
Heart failure refers to a clinical syndrome caused by structural or functional cardiac disorders that prevent the heart from pumping an adequate amount of blood to meet the body's metabolic needs. This condition often arises from myocardial infarction or ischemia, leading to decreased cardiac output, reduced tissue perfusion, impaired gas exchange, fluid volume imbalance, and decreased functional ability.Heart failure can result from disruptions in the mechanisms that regulate cardiac output...
951
01:22Heart Failure VI: Adjunct Therapies
395
Additional therapies for treating patients with heart failure (HF) may include procedural interventions, supplemental oxygen, the management of sleep disorders, and nutritional therapy.Procedural InterventionsImplantable Cardioverter-Defibrillator: For patients at risk of life-threatening arrhythmias due to severe left ventricular dysfunction, an Implantable Cardioverter-Defibrillator (ICD) can detect and terminate these arrhythmias, preventing sudden cardiac death and improving survival rates.
395
01:22Heart Failure Drugs: Diuretics
1.0K
Heart failure and kidney perfusion are interconnected in a complex way. Reduced renal perfusion and venous congestion are two significant factors that contribute to renal dysfunction in heart failure. The kidneys, primarily responsible for fluid balance in the body, are adversely affected due to compromised cardiac output and increased venous pressure. In response to reduced renal perfusion, the kidneys activate neurohumoral mechanisms to restore balance. However, these mechanisms can be...
1.0K