Is preventive medicine responsible for the increasing prevalence of heart failure?

Abstract

infarction. Risk factor~, responsible for the development and progression of atherosclerotic coronary artery disease are well known. The factors that predispose patients with coronary disease to the development of heart failure are not clear, but recurrent infarction is a major factor. Hoffman and colleagues 3 studied all patients with documented coronary artery disease eligible for the multicentre, randomised, controlled Coronary Artery Surgery Study to find out which modifiable cardiovascular risk factors predispose to heart failure. At the 12-year follow-up, the cumulative incidence of heart failure was 20.6%. Cigarette smoking, high body-mass index, myocardial infarction during follow-up, older age, female sex, and baseline left-ventricle dysfunction were risk factors for the development of heart failure. Other factors have also been implicated such as: myocardial wall stress, uncorrected myocardial ischaemia, persistent coronary artery occlusion, and neurohormonal (particularly renin-angiotensin and sympathetic) overactivity. The Framingham study ~ also identified the following independent risk factors for the development of heart failure: low vital capacity, rapid heart rate, diabetes, cardiac enlargement, high body-mass index (in women), high serum cholesterol (in men aged <65 years), cigarette smoking, proteinuria, and high haematocrit. These risk factors were in addition to hypertension, evidence of leftventricle hypertrophy on electrocardiogram (ECG), and coronary disease. The findings of this study would suggest that conventional strategies for secondary prevention of coronary artery disease may work as primary preventive measures of heart failure. There is evidence showing this effect in a number of settings.