Background: The number of people in the United States with heart failure (HF) is expected to rise dramatically as the population ages unless efforts to prevent HF improve.
Methods and results: PubMed/MEDLINE searches were conducted to identify treatment trials of hypertension, hypercholesterolemia, asymptomatic left ventricular systolic dysfunction, and diabetes that reported HF incidence. Treatment of hypertension reduces the incidence of HF by approximately 50%, even among very elderly patients. Diuretics, beta-blockers, and angiotensin-converting enzyme (ACE) inhibitors appear more effective than calcium channel blockers and doxazosin. Hydroxy methylglutaryl coenzyme A (HMG CoA) reductase inhibitors reduce the incidence of HF by approximately 20% among patients with hypercholesterolemia and coronary artery disease. ACE inhibitors reduce HF incidence by 37% among patients with reduced systolic function and by 23% among patients with coronary artery disease and normal systolic function. Observational studies have shown lower HF incidence among people with diabetes with better glycemic control. Unfortunately, all of these effective therapies appear to be underused, and control of hypertension is particularly poor.
Conclusions: If clinical practice can live up to the potential shown from clinical trials, the suffering and economic toll imposed by HF can be dramatically reduced. Improved control of hypertension, primary prevention of myocardial infarction, and more widespread use of secondary prevention measures are essential.