Baker David W
Center for Health Care Research and Policy, Case Western Reserve University at MetroHealth Medical Center, Cleveland, Ohio, USA.
J Card Fail. 2002 Oct;8(5):333-46. doi: 10.1054/jcaf.2002.0805333.
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.
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.
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.
在美国，除非预防心力衰竭（HF）的措施得到改善，否则随着人口老龄化，HF患者数量预计将急剧上升。
通过PubMed/MEDLINE检索，以确定报告HF发病率的高血压、高胆固醇血症、无症状左心室收缩功能障碍和糖尿病的治疗试验。高血压治疗可使HF发病率降低约50%，即使在高龄患者中也是如此。利尿剂、β受体阻滞剂和血管紧张素转换酶（ACE）抑制剂似乎比钙通道阻滞剂和多沙唑嗪更有效。羟甲基戊二酰辅酶A（HMG CoA）还原酶抑制剂可使高胆固醇血症和冠状动脉疾病患者的HF发病率降低约20%。ACE抑制剂可使收缩功能降低的患者HF发病率降低37%，使冠状动脉疾病且收缩功能正常的患者HF发病率降低23%。观察性研究表明，血糖控制较好的糖尿病患者HF发病率较低。不幸的是，所有这些有效疗法似乎都未得到充分应用，高血压的控制尤其差。
如果临床实践能够达到临床试验所显示的潜力，HF所带来的痛苦和经济损失可大幅降低。改善高血压控制、心肌梗死的一级预防以及更广泛地使用二级预防措施至关重要。
