2003, Volume 5, Issue 4, pp 337-343
Therapies for preventing heart failure
- Richard F. Wright MD
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The prevalence of congestive heart failure is progressively increasing and despite recent advances in therapeutics, there is a continuing need for novel effective therapies. New, investigational treatment strategies include inotropic drugs, neurohormonal antagonists, anticytokine and anti-inflammatory strategies, hormonal therapies, and nutritional supplements. Current positive inotropes (eg, dobutamine and phosphodiesterase inhibitors) provide symptomatic relief, but newer agents may have a better adverse effect profile. Angiotensin-converting enzyme (ACE) inhibitors should remain first-line treatment with angiotensin receptor blockers used in ACE inhibitor-intolerant patients. Many new neurohormonal antagonists have recently been investigated and eplerenone has demonstrated clinical benefit. New hormonal, anticytokine, and anti-inflammatory therapies have shown benefit in small trials, but results in larger trials have been disappointing. Other approaches are currently being tested in large trials that will clarify their role. Nutritional supplements need to be tested in a large prospective trial before they can be recommended.
References and Recommended Reading
American Heart Association: 2002 Heart and Stroke Statistical Update. Dallas, TX: American Heart Association; 2001.
Maniolo TA, Baughmnan KL, Rodeheffer R, et al.: Prevalence and etiology of idiopathic dilated cardiomyopathy. Am J Cardiol 1992, 69:1458–1466.CrossRef
Tavazzi L, Opasich C: Clinical epidemiology of heart failure. Congest Heart Fail 1999, 5:260–269.PubMed
Lloyd-Jones DM, Larson MG, Leip EP, et al.: Lifetime risk for developing congestive heart failure: the Framingham Heart Study. Circulation 2002, 106:3068–3072. The pivotal Framingham epidemiologic investigations have contributed greatly to our current understanding of the risk factors for cardiovascular disease, and this paper continues in that vein.PubMedCrossRef
Kenchiah S, Evans JC, Levy D, et al.: Obesity and the risk of heart failure. New Engl J Med 2002, 347:305–313.CrossRef
Whelton PK, He J, Appel LJ, et al.: Primary prevention of hypertension: clinical and public health advisory from the National High Blood Pressure Education Program. JAMA 2002, 288:1882–1888. An important summation of the “state of the art” in nonpharmacologic means to avoid the development of hypertension.PubMedCrossRef
Effects of an angiotensin-converting enzyme inhibitor, ramapril, on cardiovascular events in high-risk patients. Heart Outcomes Prevention Evaluation Study Investigators [no authors listed]. N Engl J Med 2000, 342:134–153.
Davis BR, Cutler JA, Furberg CD, et al.: Relationship of antihypertensive treatment regimens and change in blood pressure to risk for heart failure in hypertensive patients randomly assigned to doxazosin or chlorthalidone: further analyses from the Antihypertensive and Lipid-Lowering treatment to prevent Heart Attack Trial. Ann Intern Med 2002, 137:313–320. Compelling evidence that not all antihypertensive therapies are equivalent in terms of patient outcomes.PubMed
Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) [no authors listed]. JAMA 2002, 288:2981–2997. Further evidence that drug choice makes a difference, in the largest antihypertensive trial ever undertaken.
Whelton SP, Chin A, Xin X, He J: Effect of aerobic exercise on blood pressure: a meta-analysis of randomized, controlled trials. Ann Intern Med 2002, 136:493–503.PubMed
Levy WC, Cerqueira MD, Abrass IG, et al.: Endurance exercise training augments diastolic filling at rest and during exercise in healthy young and older men. Circulation 1993, 88:116–126.PubMed
Arnold JM, Yusuf S, Young J, et al.: Prevention of heart failure in patients in the Heart Outcomes Prevention Evaluation (HOPE) Study. Circulation 2003, 107:1278–1284. The first trial, and most influential to date, supporting use of ACE inhibition to prevent cardiovascular events, including the development of heart failure.CrossRef
Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fractions. The SOLVD Investigators [no authors listed]. N Engl J Med 1992, 327:685–691.
Vautrimpout R, Rouleau J, Wu C-C, et al.: Additive beneficial effect of beta-blockers to angiotensin converting enzymes inhibiot in the survival and ventricular endpoint (SAVE) study. J Am Coll Cardiol 1997, 29:229–236.CrossRef
Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. The SOLVD Investigators [no authors listed]. N Engl J Med 1991, 325:293–302.
Hjalmarson A, Goldstein S, Fagerberg B, et al.: Effects of controlled-release metoprolol on total mortality, hospitalizations, and well-being in patients with heat failure: the metoprolol CR/XL randomized intervention trial in congestive heart failure (MERITHF). JAMA 2000, 283:1295–1302.PubMedCrossRef
The Cardiac Insufficiency Bisoprolol Study II (CIBIS II): a randomized trial [no authors listed]. Lancet 1999, 353:9–13.
The effect of digoxin on mortality and morbidity in patients with heart failure. The Digitalis Investigation Group [no authors listed]. N Engl J Med 1997, 336:525–533.
- Therapies for preventing heart failure
Current Treatment Options in Cardiovascular Medicine
Volume 5, Issue 4 , pp 337-343
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- 1. Pacific Heart Institute, 2001 Santa Monica Boulevard, 90404, Santa Monica, CA, USA