Heart Failure: Management and Prevention of Heart Failure Based on Current Understanding of Pathophysiological Mechanisms

Abstract

Heart failure is a clinical syndrome due to cardiac contractile dysfunction resulting from various underlying cardiovascular disorders, including ischemic heart disease (IHD), hypertension, and cardiomyopathies caused by genetic abnormalities. Cardiac pump dysfunction reduces cardiac output (forward failure), increases venous pressures (backward failure), and is accompanied by molecular abnormalities, i.e., cardiac and vascular remodeling, which cause progressive deterioration of the failing heart. Heart failure can be viewed as an end stage of final common pathway by which various etiologies damage the heart to cause disability and premature death. In developed countries, the incidence of heart failure is increasing, associated with an increase in IHD brought about by population aging and overall adaptation of a Western diet. Risk factors that finally lead to heart failure are composed of a wide range of events exacerbating cardiovascular disorders, including hypertension, diabetes mellitus, hyperlipidemia, obesity, smoking, aging, and gender (male > female). The prevention of heart failure is strongly related to the attempt to reduce or avoid these risk factors which fasten the process of IHD by facilitating atherosclerosis. Health-related quality of life of the patients is impaired by subjective symptoms and decreased exercise tolerance with a high frequency of cardiac sudden death due to lethal arrhythmias. The abnormalities in the lungs, kidneys, liver, skeletal muscle, and some other organs dominate in the clinical picture, even though these tissues are victims of impaired cardiac pump function. The compensatory mechanisms driven to reverse these abnormalities constitute the feature of heart failure as general physical disorders. The characteristics of progressive deterioration of the failing heart associated with cardiac remodeling and shortened life expectancy are crucial target for the treatment. Future approaches and achievements of genome-wide association studies and novel informatics applied to genomic, proteomic, and clinical information will be likely to accelerate advancement of understanding and pharmacological and genetic therapy in the field of prevention and management of heart failure.