Abstract
We appreciate very much Siirila-Waris et al. 1 for their excellent work on risk factors of heart failure. Progression of heart failure may be due to an initial cardiac injury, or mutation of the genetic programme, in association with activation of neurohormones and proinflammatory cytokines, resulting into immune activation, which worsens heart failure. Therefore, it may be proposed that any factor which can block neuroendocrine activation would be protective, whereas other factors that can enhance neurohormonal activity would be the risk factors of heart failure. Decreased heart rate variability, increased blood pressure variability, dyslipidemia, increased IL-6, IL-1, TNF-alpha, C-reactive protein, and adhesion molecules are other important determinants of mortality in patients of heart failure.2–4 Presence of coronary artery disease is also an important risk factor of mortality, which becomes worst if there is coexisting cardiac cachexia or obesity among these patients. Apart from above risk factors, …
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