Skip to main content

Advertisement

Log in

Are angiotensin-converting enzyme inhibitors and β-blockers making an impact on the epidemiology of heart failure?

  • Published:
Current Cardiology Reports Aims and scope Submit manuscript

Abstract

With the advent of the 21st century, heart failure has emerged as a major component of the massive public health problem of cardiovascular disease. Currently over 5 million Americans suffer from the syndrome of heart failure with significant direct treatment costs estimated to be in excess of $22 billion per year. Unfortunately, assuming present demographic and medical trends continue, these bleak statistics are expected to worsen substantially over the next two decades. Epidemiologic studies have furthered our mechanistic understanding of heart failure pathophysiology by demonstrating that many patients with this syndrome have preserved systolic function by standard indices. In a positive turn, major advances have occurred in the treatment of heart failure based on the development of clinically effective pharmacologic antagonists of the renin-angiotensin-aldosterone and sympathetic nervous systems. These agents are capable of substantially reducing the morbidity and mortality associated with heart failure. However, the importance of enhanced physician and public awareness of heart failure remains critical in the future.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. Dargie HJ, McMurray JJV, McDonagh TA: Heart failure — implications of the true size of the problem. J Intern Med 1996, 239:309–315.

    Article  PubMed  CAS  Google Scholar 

  2. Eriksson H: Heart failure: a growing public health problem. J Intern Med 1995, 237:135–141.

    Article  PubMed  CAS  Google Scholar 

  3. American Heart Association: 1988 Heart and Stroke Statistical Update. Dallas: American Heart Association; 1997.

    Google Scholar 

  4. Bonneux L, Barendregt JJ, Meeter K, et al.: Estimating clinical morbidity due to ischemic heart disease and congestive heart failure: the future rise of heart failure. Am J Public Health 1994, 84:202–208.

    Article  Google Scholar 

  5. Cowie MR, Mosterd A, Wood DA, et al.: The epidemiology of heart failure. Eur Heart J 1997, 18:208–225.

    PubMed  CAS  Google Scholar 

  6. Adams KF: Heart failure. In Manual of Clinical Problems in Adult Ambulatory Care. Edited by Dornbrand L, Hoole AJ, Fletcher RH. Philadelphia: Lippincott-Raven Publishers; 1997:142–150.

    Google Scholar 

  7. Marantz PR, Tobin JN, Wassertheil-Smoller S, et al.: The relationship between left ventricular systolic function and congestive heart failure diagnosed by clinical criteria. Circulation 1988, 77:607–612.

    PubMed  CAS  Google Scholar 

  8. Kessler KM: Heart failure with normal systolic function: update of prevalence, differential diagnosis, prognosis, and therapy. Arch Intern Med 1988, 148:2109–2111.

    Article  PubMed  CAS  Google Scholar 

  9. Luchi RJ, Taffet GE, Teasdale TA: Congestive heart failure in the elderly. J Am Geriatr Soc 1991, 39:810–825.

    PubMed  CAS  Google Scholar 

  10. Doughtery AH, Naccareilli GV, Gray EL, et al.: Congestive heart failure with normal systolic function. Am J Cardiol 1984, 54:778–782.

    Article  Google Scholar 

  11. McDermott MM, Feinglass J, Sy J, Gheorghiade M: Hospitalized congestive heart failure patients with preserved versus abnormal left ventricular systolic function: clinical characteristics and drug therapy. Am J Med 1995, 99:629–635.

    Article  PubMed  CAS  Google Scholar 

  12. Vasan RS, Benjamin EJ, Levy D: Congestive heart failure with normal left ventricular systolic function. Arch Intern Med 1996, 156:146–157.

    Article  PubMed  CAS  Google Scholar 

  13. Lenihan DJ, Gerson MC, Hoit BD, Walsh RA: Mechanisms, diagnosis, and treatment of diastolic heart failure. Am Heart J 1995, 130:153–166.

    Article  PubMed  CAS  Google Scholar 

  14. Bonow RO, Udelson JE: Left ventricular diastolic dysfunction as a cause of congestive heart failure. Ann Intern Med 1992, 117:502–510.

    PubMed  CAS  Google Scholar 

  15. Massie BM, Abdalla I: Heart failure in patients with preserved systolic left ventricular systolic function: do digoxin glycosides have a role ?. Prog Cardiovasc Dis 1998, 40:357–369.

    Article  PubMed  CAS  Google Scholar 

  16. Redfield MM, Jacobsen SJ, Burnett JC Jr., et al.: Burden of systolic and diastolic ventricular dysfunction in the community. JAMA 2003, 289:194–202. Very important publication defining the frequency of diastolic dysfunction with and without symptoms in the community. Makes the critical point of how common this phenomenon is and shows that the prognosis of patients with these abnormalities, whether symptomatic or not, is adversely effected.

    Article  PubMed  Google Scholar 

  17. The SOLVD Investigators: Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fractions. N Engl J Med 1992, 327:685–691.

    Article  Google Scholar 

  18. McDonagh TA, Morrison CE, Lawrence A, et al.: Symptomatic and asymptomatic left-ventricular systolic dysfunction in an urban population. Lancet 1997, 350:829–833.

    Article  PubMed  CAS  Google Scholar 

  19. Baker DW, Bahler RC, Finkelhor RS, Lauer MS: Screening for left ventricular dysfunction among patients with risk factors for heart failure. Am Heart J 2003, 146:736–740. Illustrates how common LV systolic dysfunction is in patients with risk factors. Supports screening of patients who are at risk.

    Article  PubMed  Google Scholar 

  20. Wang TJ, Levy D, Benjamin EJ, Vandran RS: The epidemiology of “asymptomatic” left ventricular systolic dysfunction: implications for screeningv. Am Coll Phys 2003, 138:907–916.

    Google Scholar 

  21. Levy D, Larson MG, Vasan RS, et al.: The progression from hypertension to congestive heart failure. JAMA 1996, 275:1557–1562.

    Article  PubMed  CAS  Google Scholar 

  22. Bourassa MG, Gurne O, Bangdiwala SI, et al., for the Studies of Left Ventricular Dysfunction (SOLVD) Investigators: Natural history and patterns of current practice in heart failure. J Am Coll Cardiol 1993, 22(Suppl A):14A-19A.

    Article  PubMed  CAS  Google Scholar 

  23. Gheorghiade M, Bonow RO: Chronic heart failure in the United States: a manifestation of coronary artery disease. Circulation 1998, 97:282–289.

    PubMed  CAS  Google Scholar 

  24. Ho KKL, Pinsky JL, Kannel WB, Levy D: The epidemiology of heart failure: The Framingham Study. J Am Coll Cardiol 1993, 22(Suppl A):6A-13A.

    Article  PubMed  CAS  Google Scholar 

  25. Fonarow GC, Horwich TB: Preventions of heart failure: effective strategies to combat the growing epidemic. Rev Cardiovasc Med 2003, 4:8–17.

    PubMed  Google Scholar 

  26. Fox KM, the European Trial on Reduction of Cardiac Events with Perindopril in Stable Coronary Artery Disease Investigators: Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomised, double-blind, placebo-controlled, bdmulticentre trial (the EUROPA study). Lancet 2003, 362:782–788. A major trial concerning the role of ACE inhibition in patients at risk for cardiovascular disease. Shows the efficacy of these agents in reducing the risk for adverse outcomes from cardiovascular disease in patients at risk

    Article  PubMed  CAS  Google Scholar 

  27. McKee PA, Castelli WP, McNamara PM, Kannel WB: Natural history of congestive heart failure: the Framingham Study. New Engl J Med 1971, 285:1441–1446.

    Article  PubMed  CAS  Google Scholar 

  28. Adams KF, Dunlap SH, Sueta CA, et al.: Relation between gender, etiology and survival in patients with symptomatic heart failurev. J Am Coll Cardiol 1996, 28:1781–1788.

    Article  PubMed  Google Scholar 

  29. Ghali JK, Krause-Steinrauf HJ, Adams KF, et al.: Gender differences in advanced heart failure: insights from the BEST study. J Am Coll Cardiol 2003, 42:2128–2134. Confirms previous work on the association of female sex with better outcome in heart failure due to nonischemic causes. Points way for basic studies to understand the favorable prognosis of women with this type of heart failure.

    Article  PubMed  Google Scholar 

  30. Sueta CA, Dunlap SH, Clarke SW, et al.: Improved survival in women with heart failure and LVEF = 40%. Circulation 1995, 92(Suppl):I-667.

    Google Scholar 

  31. Adams KF, Sueta CA, Califf RM, et al.: Gender differences in survival in patients with advanced heart failure. Circulation 1999, 99:1816–1821.

    PubMed  Google Scholar 

  32. Schocken DD, Arrieta Ml, Leaverson PE, Ross EA: Prevalence and mortality rate of congestive heart failure in the United States. J Am Coll Cardiol 1992, 20:301–306.

    Article  PubMed  CAS  Google Scholar 

  33. Ho KKL, Anderson KM, Kannel WB, et al.: Survival after the onset of congestive heart failure in Framingham Heart Study subjects. Circulation 1993, 88:107–115.

    PubMed  CAS  Google Scholar 

  34. Burns RB, McCarthy EP, Moskowitz MA, et al.: Outcome for older men and women with congestive heart failure. J Am Geriatr Soc 1997, 45:276–280.

    PubMed  CAS  Google Scholar 

  35. Gillium RF: Epidemiology of heart failure in the United States. Am Heart J 1993, 126:1042–1047.

    Article  Google Scholar 

  36. Dunlap SH, Mallemala S, Sueta CA, et al.: Survival rates are similar between African American and white patients with heart failure. Am Heart J 2003, 146:265–272. Heart failure is a major public health problem in black Americans. Understanding whether prognosis is intrinsically worse in this racial group is of practical clinical importance. Although additional studies will be needed, this work suggests that similar survival is possible in black and nonblack patients managed in a heart failure clinic setting.

    Article  PubMed  Google Scholar 

  37. Krum H, Gilbert RE: Demographics and concomitant disorders in heart failure. Lancet 2003, 362:147–158. Comorbidities are often overlooked as contributing factors in outcome and response to medication in patients with heart failure. This review gives and excellent description of the adverse role of these conditions in patients with heart failure. The discussion of renal dysfunction is especially important as this comorbidity emerges as a major prognostic factor in acute and chronic heart failure.

    Article  PubMed  Google Scholar 

  38. Metra M, Nodari S, Parrinello G, et al.: Marked improvement in left ventricular ejection fraction during long-term b-blockade in patients with chronic heart failure: clinical correlates and prognostic significance. Am Heart J 2003, 145:292–299. Illustrates the major prognostic impact of improving LV function in patients receiving β-blockade. Major point for clinicians caring for patients with heart failure to understand.

    Article  PubMed  Google Scholar 

  39. Peterson LR, Schechtman KB, Ewald GA, et al.: The effect of badrenergic blockers on the prognostic value of peak exercise oxygen uptake in patients with heart failure. J Heart Lung Transplant 2003, 22:70–77.

    Article  PubMed  Google Scholar 

  40. Zugck C, Haunstetter A, Krüger C, et al.: Impact of beta-blocker treatment on the prognostic value of currently used risk predictors in congestive heart failure. J Am Coll Cardiol 2002, 39:1615–1622.

    Article  PubMed  CAS  Google Scholar 

  41. Bello D, Shah DJ, Farah GM, et al.: Gadolinium cardiovascular magnetic resonance predicts reversible myocardial dysfunction and remodeling in patients with heart failure undergoing b-blocker therapy. Circulation 2003, 108:1945–1953.

    Article  PubMed  CAS  Google Scholar 

  42. Eichorn EJ, Grayburn PA, Mayer SA, et al.: for the BEST Investigators: Myocardial contractile reserve by dobutamine stress echocardiography predicts improvement in ejection fraction with b-blockade in patients with heart failure. The b-blocker Evaluation of Survival Trial (BEST). Circulation 2003, 108:2336–2341. Understanding the factors that may predict response to β-blockers in patients with heart failure is important. This study shows that myocardial reserve is one such predictor.

    Article  CAS  Google Scholar 

  43. Groenning BA, Nilsson JC, Hildebrandt PR, et al.: Neurohormonal prediction of left ventricular morphologic response to beta blockade with metoprolol in chronic left ventricular systolic heart failure.

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Adams, K.F. Are angiotensin-converting enzyme inhibitors and β-blockers making an impact on the epidemiology of heart failure?. Curr Cardiol Rep 6, 162–168 (2004). https://doi.org/10.1007/s11886-004-0018-7

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11886-004-0018-7

Keywords

Navigation