Multipronged Approach to the Prevention of Heart Failure

Heart failure (HF) is the most common cause of hospitalization in the United States and accounts for the highest ($39.2 billion) annual health care costs, with about 1,000,00 new cases every year. Dr. Javed Butler (Chair of Cardiovascular Research at University of Mississippi Medical Center) stressed the importance of the preventive strategy of heart failure at the American Society of Preventive Cardiology (ASPC) 2021 Virtual Summit.

It has been recently recognized that there is an important role for prevention of HF. The following domains in prevention have been shown to be particularly beneficial.

1. Hypertension: A diligent control of hypertension can lead to a reduction in HF occurrence by 52% and a decrease in left ventricular hypertrophy by 35%. ¹ A strict blood pressure control with a target of 120/80 mmHg has remarkable benefits in preventing HF regardless of age, as revealed in the results of the SPRINT trial.²
2. Diabetes Mellitus: Diabetes increases the HF risk by 2-4 times.³ The prevention of HF in diabetics is linked to specific therapies and not directly linked to the intensity of diabetes control. Angiotensin-converting enzyme inhibitors or Angiotensinogen receptor blockers are known to reduce HF incidence. Sodium-Glucose Transporter-2 inhibitors (SGLT-2-i) have shown the most robust evidence in preventing HF.⁴ Albiglutide is the only glucagon-like peptide-1(GLP-1) inhibitor shown to prevent HF.
3. Weight loss: Exercises or Bariatric surgery leading to weight loss has proven to be a substantial factor in preventing HF. Prompt identification and treatment of obstructive sleep apnea also prevent the onset of HF.
4. Diet: A healthy low salt diet, regular exercise, smoking cessation, and lowering of low-density lipoprotein are also beneficial in reducing the new-onset HF.

Moreover, Dr. Butler stressed that HF has similar mortality and morbidity compared to acute myocardial infarction and just as risk factor modification has improved outcomes for atherosclerotic disease. Routine risk factor screening for HF coupled with an effective preventive strategy may lead to improved quality of life and a decreased incidence of HF.

References

1. Moser M, Hebert PR. Prevention of disease progression, left ventricular hypertrophy and congestive heart failure in hypertension treatment trials. J Am Coll Cardiol. 1996;27(5):1214-1218.
2. Lewis CE, Fine LJ, Beddhu S, et al. Final Report of a Trial of Intensive versus Standard Blood-Pressure Control. N Engl J Med. 2021;384(20):1921-1930.
3. Bertoni AG, Hundley WG, Massing MW, Bonds DE, Burke GL, Goff DC, Jr. Heart failure prevalence, incidence, and mortality in the elderly with diabetes. Diabetes Care. 2004;27(3):699-703.
4. Zelniker TA, Wiviott SD, Raz I, et al. SGLT2 inhibitors for primary and secondary prevention of cardiovascular and renal outcomes in type 2 diabetes: a systematic review and meta-analysis of cardiovascular outcome trials. Lancet. 2019;393(10166):31-39.