Section 3: Prevention of Ventricular Remodeling, Cardiac Dysfunction, and Heart Failure
2006; Elsevier BV; Volume: 12; Issue: 1 Linguagem: Inglês
10.1016/j.cardfail.2005.11.008
ISSN1532-8414
AutoresHeart Failure Society of America,
Tópico(s)Cardiac Health and Mental Health
ResumoOverviewHeart failure (HF) is an all-too-frequent outcome of hypertension and arterial vascular disease, making it a major concern in public heath and preventive medicine.1Centers for Disease Control and Prevention Changes in mortality from heart failure—United States, 1980–1995.JAMA. 1998; 280: 874-875Crossref PubMed Scopus (2) Google Scholar, 2Centers for Disease Control and Prevention Mortality from congestive heart failure—United States, 1980–1990.JAMA. 1994; 271: 813-814Crossref PubMed Scopus (14) Google Scholar Epidemiologic, clinical, and basic research have identified a number of antecedent conditions that predispose individuals to HF and its predecessors, left ventricular (LV) remodeling and dysfunction.3Fox K.F. Cowie M.R. Wood D.A. Coats A.J. Gibbs J.S. Underwood S.R. et al.Coronary artery disease as the cause of incident heart failure in the population.Eur Heart J. 2001; 22: 228-236Crossref PubMed Scopus (299) Google Scholar, 4Howard B.V. Blood pressure in 13 American Indian communities: the Strong Heart Study.Public Health Rep. 1996; 111: 47-48PubMed Google Scholar, 5Grundy S.M. Balady G.J. Criqui M.H. Fletcher G. Greenland P. Hiratzka L.F. et al.Primary prevention of coronary heart disease: guidance from Framingham: a statement for healthcare professionals from the AHA Task Force on Risk Reduction. American Heart Association.Circulation. 1998; 97: 1876-1887Crossref PubMed Scopus (510) Google Scholar, 6Hellermann J.P. Jacobsen S.J. Reeder G.S. Lopez-Jimenez F. Weston S.A. Roger V.L. Heart failure after myocardial infarction: prevalence of preserved left ventricular systolic function in the community.Am Heart J. 2003; 145: 742-748Abstract Full Text PDF PubMed Scopus (45) Google Scholar, 7Kenchaiah S. Evans J.C. Levy D. Wilson P.W. Benjamin E.J. Larson M.G. et al.Obesity and the risk of heart failure.N Engl J Med. 2002; 347: 305-313Crossref PubMed Scopus (2125) Google Scholar, 8Kjekshus J. Pedersen T.R. Olsson A.G. Faergeman O. Pyorala K. The effects of simvastatin on the incidence of heart failure in patients with coronary heart disease.J Card Fail. 1997; 3: 249-254Abstract Full Text PDF PubMed Scopus (338) Google Scholar, 9Levy D. Larson M.G. Vasan R.S. Kannel W.B. Ho K.K. The progression from hypertension to congestive heart failure.JAMA. 1996; 275: 1557-1562Crossref PubMed Google Scholar, 10Lopes A.A. Andrade J. Noblat A.C. Silveira M.A. Reduction in diastolic blood pressure and cardiovascular mortality in nondiabetic hypertensive patients. A reanalysis of the HOT study.Arq Bras Cardiol. 2001; 77: 132-137PubMed Google Scholar, 11Stratton I.M. Adler A.I. Neil H.A. Matthews D.R. Manley S.E. Cull C.A. et al.Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study.BMJ. 2000; 321: 405-412Crossref PubMed Scopus (6818) Google Scholar Recognition that many of these risk factors can be modified and that treating HF is difficult and costly has focused attention on preventive strategies for HF.Development of both systolic and diastolic dysfunction related to adverse ventricular remodeling may take years to produce significant ill effects.12Pfeffer J.M. Pfeffer M.A. Fletcher P. Fishbein M.C. Braunwald E. Favorable effects of therapy on cardiac performance in spontaneously hypertensive rats.Am J Physiol. 1982; 242: H776-H784PubMed Google Scholar, 13Pearson T.A. Blair S.N. Daniels S.R. Eckel R.H. Fair J.M. Fortmann S.P. et al.AHA Guidelines for Primary Prevention of Cardiovascular Disease and Stroke: 2002 Update: Consensus Panel Guide to Comprehensive Risk Reduction for Adult Patients Without Coronary or Other Atherosclerotic Vascular Diseases. American Heart Association Science Advisory and Coordinating Committee.Circulation. 2002; 106: 388-391Crossref PubMed Scopus (1610) Google Scholar, 14Moser M. Hebert P.R. Prevention of disease progression, left ventricular hypertrophy and congestive heart failure in hypertension treatment trials.J Am Coll Cardiol. 1996; 27: 1214-1218Abstract Full Text PDF PubMed Scopus (294) Google Scholar, 15Mitchell G.F. Pfeffer J.M. Pfeffer M.A. The transition to failure in the spontaneously hypertensive rat.Am J Hypertens. 1997; 10: 120S-126SCrossref PubMed Google Scholar, 16McKee P.A. Castelli W.P. McNamara P.M. Kannel W.B. The natural history of congestive heart failure: the Framingham study.N Engl J Med. 1971; 285: 1441-1446Crossref PubMed Scopus (2579) Google Scholar, 17McDonagh T.A. Morrison C.E. Lawrence A. Ford I. Tunstall-Pedoe H. McMurray J.J. et al.Symptomatic and asymptomatic left-ventricular systolic dysfunction in an urban population.Lancet. 1997; 350: 829-833Abstract Full Text Full Text PDF PubMed Scopus (551) Google Scholar, 18Kostis J.B. Davis B.R. Cutler J. Grimm Jr., R.H. Berge K.G. Cohen J.D. et al.Prevention of heart failure by antihypertensive drug treatment in older persons with isolated systolic hypertension. SHEP Cooperative Research Group.JAMA. 1997; 278: 212-216Crossref PubMed Google Scholar Although the precise mechanisms for the transition to symptomatic HF are not clear, many modifiable factors have been identified that predispose or aggravate the remodeling process and the development of cardiac dysfunction. Treatment of systemic hypertension, with or without LV hypertrophy, reduces the development of HF.19Baker D.W. Prevention of heart failure.J Card Fail. 2002; 8: 333-346Abstract Full Text Full Text PDF PubMed Scopus (69) Google Scholar, 20Lauer M.S. Anderson K.M. Levy D. Influence of contemporary versus 30-year blood pressure levels on left ventricular mass and geometry: the Framingham Heart Study.J Am Coll Cardiol. 1991; 18: 1287-1294Abstract Full Text PDF PubMed Scopus (126) Google Scholar, 21United Kingdom Prospective Diabetes Study (UKPDS) 13: Relative efficacy of randomly allocated diet, sulphonylurea, insulin, or metformin in patients with newly diagnosed non-insulin dependent diabetes followed for three years.BMJ. 1995; 310: 83-88Crossref PubMed Scopus (89) Google Scholar, 22Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. UK Prospective Diabetes Study Group.BMJ. 1998; 317: 713-720Crossref PubMed Google Scholar, 23Adler A.I. Stratton I.M. Neil H.A. Yudkin J.S. Matthews D.R. Cull C.A. et al.Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): prospective observational study.BMJ. 2000; 321: 412-419Crossref PubMed Scopus (1685) Google Scholar, 24Arnold J.M. Yusuf S. Young J. Mathew J. Johnstone D. Avezum A. et al.Prevention of Heart Failure in Patients in the Heart Outcomes Prevention Evaluation (HOPE) Study.Circulation. 2003; 107: 1284-1290Crossref PubMed Scopus (221) Google Scholar, 25Fagard R.H. Staessen J.A. Treatment of isolated systolic hypertension in the elderly: the Syst-Eur trial. Systolic Hypertension in Europe (Syst-Eur) Trial Investigators.Clin Exp Hypertens. 1999; 21: 491-497Crossref PubMed Scopus (39) Google Scholar, 26Hansson L. Recent intervention trials in hypertension initiated in Sweden—HOT, CAPPP and others. Hypertension Optimal Treatment Study. Captopril Prevention Project.Clin Exp Hypertens. 1999; 21: 507-515Crossref PubMed Scopus (12) Google Scholar, 27Hawkins C.M. Isolated systolic hypertension, morbidity, and mortality: The SHEP Experience.Am J Geriatr Cardiol. 1993; 2: 25-27PubMed Google Scholar Prevention of myocardial infarction (MI) in patients with atherosclerotic cardiovascular disease is a critical intervention, since occurrence of MI confers an 8- to 10-fold increased risk for subsequent HF.24Arnold J.M. Yusuf S. Young J. Mathew J. Johnstone D. Avezum A. et al.Prevention of Heart Failure in Patients in the Heart Outcomes Prevention Evaluation (HOPE) Study.Circulation. 2003; 107: 1284-1290Crossref PubMed Scopus (221) Google Scholar Other modifiable risk factors include diabetes, hyperlipidemia, obesity, valvular abnormalities, alcohol, certain illicit drugs, and some cardiotoxic medications.28He J. Ogden L.G. Bazzano L.A. Vupputuri S. Loria C. Whelton P.K. Risk factors for congestive heart failure in US men and women: NHANES I epidemiologic follow-up study.Arch Intern Med. 2001; 161: 996-1002Crossref PubMed Scopus (909) Google ScholarPatients With Risk Factors for Ventricular Remodeling, Cardiac Dysfunction, and HFRecommendations3.1A careful and thorough clinical assessment, with appropriate investigation for known or potential risk factors, is recommended in an effort to prevent development of LV remodeling, cardiac dysfunction, and HF. These risk factors include, but are not limited to, hypertension, hyperlipidemia, atherosclerosis, diabetes mellitus, valvular disease, obesity, physical inactivity, excessive alcohol intake, and smoking. (Strength of Evidence = A)3.2The recommended goals for the management of specific risk factors for the development of cardiac dysfunction and HF are shown in Table 3.1.Table 3.1Goals for the Management of Risk Factors for the Development of HFRisk FactorPopulationTreatment GoalStrength of EvidenceHypertensionNo diabetes or renal disease< 140/90 mm HgADiabetes< 130/80 mm HgARenal insufficiency >1 g/day of proteinuria125/75ARenal insufficiency ≤1 g/day of proteinuria130/85ADiabetesSee American Diabetes Association (ADA) GuidelineHyperlipidemiaSee National Cholesterol Education Program (NCEP) GuidelinePhysical inactivityEveryoneSustained aerobic activity 20–30 minutes, 3–5 times weeklyBObesityEveryone BMI ≥30Weight reduction BMI 160/110 mm Hg) and least in those with mild hypertension (>145/95 mm Hg). Optimal blood pressure is not known. Data from recent trials suggest that 130/80 mm Hg or lower is the optimal blood pressure for patients with documented end-organ disease (diabetes with nephropathy, patients with proteinuria).38Chobanian A.V. Bakris G.L. Black H.R. Cushman W.C. Green L.A. Izzo Jr., J.L. et al.The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report.JAMA. 2003; 289: 2560-2572Crossref PubMed Scopus (16366) Google Scholar The World Health Organization has suggested an optimal blood pressure of 115/75 mm Hg for individuals with no documented end-organ disease. It is unclear whether additional therapy to lower blood pressure further will confer additional benefit.Restriction of dietary sodium intake has been associated with improved blood pressure similar to single drug therapy. The Dietary Approaches to Stop Hypertension (ie, DASH) diet, rich in potassium and calcium, has been associated with a reduced incidence of hypertension requiring drug therapy.39Craddick S.R. Elmer P.J. Obarzanek E. Vollmer W.M. Svetkey L.P. Swain M.C. The DASH diet and blood pressure.Curr Atheroscler Rep. 2003; 5: 484-491Crossref PubMed Scopus (44) Google Scholar See Table 3.2 for sodium equivalents.Table 3.2Sodium EquivalentsSaltSodium ChlorideSodium¼ teaspoon1550 mg600 mg½ teaspoon3100 mg1200 mg¾ teaspoon4650 mg1800 mg1 teaspoon6100 mg2400 mg Open table in a new tab Hyperlipidemia. In a large randomized study of a statin versus placebo in patients with MI and elevated low-density lipoprotein, treatment with a statin was associated with a highly significant reduction in all-cause mortality and recurrent MI.8Kjekshus J. Pedersen T.R. Olsson A.G. Faergeman O. Pyorala K. The effects of simvastatin on the incidence of heart failure in patients with coronary heart disease.J Card Fail. 1997; 3: 249-254Abstract Full Text PDF PubMed Scopus (338) Google Scholar, 32Krum H. McMurray J.J. Statins and chronic heart failure: do we need a large-scale outcome trial?.J Am Coll Cardiol. 2002; 39: 1567-1573Abstract Full Text Full Text PDF PubMed Scopus (123) Google Scholar A 20% reduction in the incidence of HF was noted in patients treated with statin therapy. Recurrent MI during this study was associated with a large relative increase in mortality and HF.Obesity. The American Heart Association and the European Society of Cardiology recommend an ideal body mass index (BMI) of 25–27 kg/m2. (BMI is calculated by dividing the patient's weight in kilograms by his or her height in meters squared.) Obesity is defined as a BMI ≥30, overweight as a BMI ≥25. Obesity is associated with the metabolic syndrome, increasingly accepted as a major risk factor for the development of cardiovascular disease. Excessive body fat results in increased metabolic demand, ventricular hypertrophy, and sleep-disordered breathing, all of which promote the development of HF. The relationship between obesity and the risk of HF is well established.7Kenchaiah S. Evans J.C. Levy D. Wilson P.W. Benjamin E.J. Larson M.G. et al.Obesity and the risk of heart failure.N Engl J Med. 2002; 347: 305-313Crossref PubMed Scopus (2125) Google Scholar There is an increasing body of opinion that obesity is associated with a distinct form of cardiomyopathy.Weight reduction has been shown to improve most of the adverse effects of obesity. It is likely that weight reduction by obese individuals reduces the likelihood of subsequent HF, although no data exist to confirm this hypothesis.Physical Inactivity. The benefits of exercise are well documented and include reduction of recurrent MI in survivors of MI, improved exercise capacity, improved affect and quality of life, and better control of hypertension. These results are achieved with a minimum of 20–30 minutes of sustained submaximal exercise 3–5 times per week (see Section 6).40Pina I.L. Apstein C.S. Balady G.J. Belardinelli R. Chaitman B.R. Duscha B.D. et al.Exercise and heart failure: a statement from the American Heart Association Committee on exercise, rehabilitation, and prevention.Circulation. 2003; 107: 1210-1225Crossref PubMed Scopus (801) Google ScholarAlcohol Intake. Alcoholic cardiomyopathy is associated with very substantial intake of alcohol (70 g or greater per day of chronic ingestion). Avoiding substantial ingestion of alcohol is clearly advisable, but the safe level of moderate ingestion has been difficult to define. There are conflicting reports regarding the effects of alcohol ingestion upon left ventricular ejection fraction (LVEF) in those with and without HF. At present, 2 drinks per day for men and 1 drink per day for women is considered acceptable, even in individuals with other cardiovascular risk factors. See Table 3.3 for drink equivalents. Those with for a propensity to abuse alcohol should be counseled to abstain.Table 3.3Alcohol EquivalentsOne drink12–14 g alcohol1.5 oz. 80-proof spirits12 oz. beer5 oz. wine Open table in a new tab Smoking Cessation. There is a substantial body of data concerning the adverse effects of smoking in patients with vascular disease or reduced LVEF. Smoking cessation is associated with a 50% reduction in 5-year mortality in survivors of acute MI.41Burt A. Thornley P. Illingworth D. White P. Shaw T.R. Turner R. Stopping smoking after myocardial infarction.Lancet. 1974; 1: 304-306Abstract PubMed Scopus (110) Google Scholar In the Studies of Left Ventricular Dysfunction (SOLVD) study of patients with either symptomatic or asymptomatic LV dysfunction, nonsmokers or former smokers showed improved mortality when compared with current smokers.42Jay S.J. Smoking is an important component in the analysis of heart failure.Arch Intern Med. 1999; 159: 2225-2226Crossref PubMed Google Scholar, 43Nicolozakes A.W. Binkley P.F. Leier C.V. Hemodynamic effects of smoking in congestive heart failure.Am J Med Sci. 1988; 296: 377-380Crossref PubMed Scopus (16) Google Scholar These and other observational data suggest smoking cessation dramatically reduces adverse outcomes in patients with established vascular disease and those with established ventricular remodeling or dysfunction.Recommendations3.3Angiotensin-converting enzyme (ACE) inhibitors are recommended for prevention of HF in patients at high risk of this syndrome, including those with coronary artery disease, peripheral vascular disease, or stroke. Patients with diabetes and another major risk factor or patients with diabetes who smoke or have microalbuminuria are also at high risk and should receive ACE inhibitors. (Strength of Evidence = A)BackgroundFindings from at least three randomized, controlled trials support the use of ACE inhibitors in patients at high risk for the development of HF. In 1 study of patients older than age 55 with documented vascular disease or multiple cardiac risk factors, including diabetes, treatment with an ACE inhibitor reduced the annual risk of developing HF by 23%.24Arnold J.M. Yusuf S. Young J. Mathew J. Johnstone D. Avezum A. et al.Prevention of Heart Failure in Patients in the Heart Outcomes Prevention Evaluation (HOPE) Study.Circulation. 2003; 107: 1284-1290Crossref PubMed Scopus (221) Google Scholar A study of patients older than age 18 with documented coronary artery disease showed that treatment with an ACE inhibitor reduced total mortality by 14% over 4.2 years, even though patients were already receiving aggressive treatment for vascular disease.44Fox K.M. Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomised, double-blind, placebo-controlled, multicentre trial (the EUROPA study).Lancet. 2003; 362: 782-788Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar In a third study, patients with previous stroke and mild hypertension treated with an ACE inhibitor–based antihypertensive regimen showed a 26% reduction in subsequent HF.36Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6,105 individuals with previous stroke or transient ischaemic attack.Lancet. 2001; 358: 1033-1041Abstract Full Text Full Text PDF PubMed Scopus (2958) Google ScholarRecommendation3.4β-blockers are recommended for patients with prior MI to reduce mortality, recurrent MI, and the development of HF. (Strength of Evidence = A)Backgroundβ-blockers are known to reduce cardiac ischemia, reinfarction, and myocardial remodeling after acute MI. Studies in patients with recent MI (most published in the prethrombolytic era) have shown that β-blockers are associated with a large reduction in HF and recurrent all-cause hospitalizations, HF hospitalizations, and recurrent MI.45The beta-blocker heart attack trial. Beta-Blocker Heart Attack Study Group.JAMA. 1981; 246: 2073-2074Crossref PubMed Scopus (296) Google Scholar, 46A randomized trial of propranolol in patients with acute myocardial infarction. II. Morbidity results.JAMA. 1983; 250: 2814-2819Crossref PubMed Scopus (167) Google Scholar, 47Reduction of infarct size by the early use of intravenous timolol in acute myocardial infarction. International Collaborative Study Group.Am J Cardiol. 1984; 54: 14E-15EAbstract Full Text PDF PubMed Scopus (5) Google Scholar, 48Exner D.V. Dries D.L. Waclawiw M.A. Shelton B. Domanski M.J. Beta-adrenergic blocking agent use and mortality in patients with asymptomatic and symptomatic left ventricular systolic dysfunction: a post hoc analysis of the Studies of Left Ventricular Dysfunction.J Am Coll Cardiol. 1999; 33: 916-923Abstract Full Text Full Text PDF PubMed Scopus (136) Google Scholar, 49Vantrimpont P. Rouleau J.L. Wun C.C. Ciampi A. Klein M. Sussex B. et al.Additive beneficial effects of beta-blockers to angiotensin-converting enzyme inhibitors in the Survival and Ventricular Enlargement (SAVE) Study. SAVE Investigators.J Am Coll Cardiol. 1997; 29: 229-236Abstract Full Text Full Text PDF PubMed Scopus (207) Google Scholar, 50Simon T. Mary-Krause M. Funck-Brentano C. Lechat P. Jaillon P. Bisoprolol dose-response relationship in patients with congestive heart failure: a subgroup analysis in the cardiac insufficiency bisoprolol study (CIBIS II).Eur Heart J. 2003; 24: 552-559Crossref PubMed Scopus (108) Google Scholar, 51Rodda B.E. The Timolol Myocardial Infarction Study: an evaluation of selected variables.Circulation. 1983; 67: I101-I106Crossref PubMed Scopus (44) Google Scholar, 52Roque F. Amuchastegui L.M. Lopez Morillos M.A. Mon G.A. Girotti A.L. Drajer S. et al.Beneficial effects of timolol on infarct size and late ventricular tachycardia in patients with acute myocardial infarction.Circulation. 1987; 76: 610-617Crossref PubMed Scopus (17) Google Scholar, 53Pratt C.M. Roberts R. Chronic beta blockade therapy in patients after myocardial infarction.Am J Cardiol. 1983; 52: 661-664Abstract Full Text PDF PubMed Scopus (14) Google Scholar, 54Lund-Johansen P. The Norwegian Multicenter Study on timolol after myocardial infarction. Part II. Effect in different risk groups, causes of death, heart arrest, reinfarctions, rehospitalizations and adverse experiences.Acta Med Scand Suppl. 1981; 651: 243-252PubMed Google Scholar More recent observational data confirm this finding, showing risk reduction for the development of HF in the 25% to 45% range 1 year after MI.55Dargie H.J. Effect of carvedilol on outcome after myocardial infarction in patients with left-ventricular dysfunction: the CAPRICORN randomised trial.Lancet. 2001; 357: 1385-1390Abstract Full Text Full Text PDF PubMed Scopus (1446) Google Scholar Patients most at risk for HF and death after MI—women and patients with advanced age, diabetes, renal disease, or previous revascularization—appear to derive the most benefit, but unfortunately are less likely to receive β-blockade post MI.56Krumholz H.M. Radford M.J. Wang Y. Chen J. Heiat A. Marciniak T.A. National use and effectiveness of beta-blockers for the treatment of elderly patients after acute myocardial infarction: National Cooperative Cardiovascular Project.JAMA. 1998; 280: 623-629Crossref PubMed Scopus (446) Google Scholar, 57Soumerai S.B. McLaughlin T.J. Spiegelman D. Hertzmark E. Thibault G. Goldman L. Adverse outcomes of underuse of beta-blockers in elderly survivors of acute myocardial infarction.JAMA. 1997; 277: 115-121Crossref PubMed Google Scholar Overview Heart failure (HF) is an all-too-frequent outcome of hypertension and arterial vascular disease, making it a major concern in public heath and preventive medicine.1Centers for Disease Control and Prevention Changes in mortality from heart failure—United States, 1980–1995.JAMA. 1998; 280: 874-875Crossref PubMed Scopus (2) Google Scholar, 2Centers for Disease Control and Prevention Mortality from congestive heart failure—United States, 1980–1990.JAMA. 1994; 271: 813-814Crossref PubMed Scopus (14) Google Scholar Epidemiologic, clinical, and basic research have identified a number of antecedent conditions that predispose individuals to HF and its predecessors, left ventricular (LV) remodeling and dysfunction.3Fox K.F. Cowie M.R. Wood D.A. Coats A.J. Gibbs J.S. Underwood S.R. et al.Coronary artery disease as the cause of incident heart failure in the population.Eur Heart J. 2001; 22: 228-236Crossref PubMed Scopus (299) Google Scholar, 4Howard B.V. Blood pressure in 13 American Indian communities: the Strong Heart Study.Public Health Rep. 1996; 111: 47-48PubMed Google Scholar, 5Grundy S.M. Balady G.J. Criqui M.H. Fletcher G. Greenland P. Hiratzka L.F. et al.Primary prevention of coronary heart disease: guidance from Framingham: a statement for healthcare professionals from the AHA Task Force on Risk Reduction. American Heart Association.Circulation. 1998; 97: 1876-1887Crossref PubMed Scopus (510) Google Scholar, 6Hellermann J.P. Jacobsen S.J. Reeder G.S. Lopez-Jimenez F. Weston S.A. Roger V.L. Heart failure after myocardial infarction: prevalence of preserved left ventricular systolic function in the community.Am Heart J. 2003; 145: 742-748Abstract Full Text PDF PubMed Scopus (45) Google Scholar, 7Kenchaiah S. Evans J.C. Levy D. Wilson P.W. Benjamin E.J. Larson M.G. et al.Obesity and the risk of heart failure.N Engl J Med. 2002; 347: 305-313Crossref PubMed Scopus (2125) Google Scholar, 8Kjekshus J. Pedersen T.R. Olsson A.G. Faergeman O. Pyorala K. The effects of simvastatin on the incidence of heart failure in patients with coronary heart disease.J Card Fail. 1997; 3: 249-254Abstract Full Text PDF PubMed Scopus (338) Google Scholar, 9Levy D. Larson M.G. Vasan R.S. Kannel W.B. Ho K.K. The progression from hypertension to congestive heart failure.JAMA. 1996; 275: 1557-1562Crossref PubMed Google Scholar, 10Lopes A.A. Andrade J. Noblat A.C. Silveira M.A. Reduction in diastolic blood pressure and cardiovascular mortality in nondiabetic hypertensive patients. A reanalysis of the HOT study.Arq Bras Cardiol. 2001; 77: 132-137PubMed Google Scholar, 11Stratton I.M. Adler A.I. Neil H.A. Matthews D.R. Manley S.E. Cull C.A. et al.Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study.BMJ. 2000; 321: 405-412Crossref PubMed Scopus (6818) Google Scholar Recognition that many of these risk factors can be modified and that treating HF is difficult and costly has focused attention on preventive strategies for HF. Development of both systolic and diastolic dysfunction related to adverse ventricular remodeling may take years to produce significant ill effects.12Pfeffer J.M. Pfeffer M.A. Fletcher P. Fishbein M.C. Braunwald E. Favorable effects of therapy on cardiac performance in spontaneously hypertensive rats.Am J Physiol. 1982; 242: H776-H784PubMed Google Scholar, 13Pearson T.A. Blair S.N. Daniels S.R. Eckel R.H. Fair J.M. Fortmann S.P. et al.AHA Guidelines for Primary Prevention of Cardiovascular Disease and Stroke: 2002 Update: Consensus Panel G
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