Fonarow Gregg C, Horwich Tamara B
Ahmanson-UCLA Cardiomyopathy Center, Division of Cardiology, The David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Rev Cardiovasc Med. 2003 Winter;4(1):8-17.
In light of the increasing prevalence, morbidity, and mortality of heart failure, effective preventative strategies are urgently needed. Risk factors for heart failure include coronary artery disease and other atherosclerotic vascular diseases, hypertension, diabetes, renal insufficiency, obesity, and family history of cardiomyopathy. Essential strategies for prevention of heart failure are modification of risk factors for heart failure development; comprehensive hypertension, atherosclerosis, and diabetes treatment; and detection and treatment of asymptomatic left ventricular dysfunction. The B-type natriuretic peptide assay may aid in identifying asymptomatic left ventricular dysfunction in patients with risk factors for heart failure. In patients with hypertension, atherosclerosis, and/or diabetes, angiotensin-converting enzyme inhibitor, beta-blocker, aspirin, and statin therapy can prevent progression to symptomatic heart failure. Avoidance of calcium channel-blockers as first-line antihypertensive therapy can also reduce the risk of heart failure. There remain substantial opportunities to improve implementation of therapies proven to prevent heart failure in the large number of patients at risk.
鉴于心力衰竭的患病率、发病率和死亡率不断上升，迫切需要有效的预防策略。心力衰竭的危险因素包括冠状动脉疾病和其他动脉粥样硬化性血管疾病、高血压、糖尿病、肾功能不全、肥胖以及心肌病家族史。预防心力衰竭的基本策略是改变心力衰竭发生的危险因素；全面治疗高血压、动脉粥样硬化和糖尿病；以及检测和治疗无症状左心室功能障碍。B型利钠肽检测可能有助于识别有心力衰竭危险因素患者的无症状左心室功能障碍。对于高血压、动脉粥样硬化和/或糖尿病患者，血管紧张素转换酶抑制剂、β受体阻滞剂、阿司匹林和他汀类药物治疗可预防进展为有症状的心力衰竭。避免将钙通道阻滞剂作为一线抗高血压治疗也可降低心力衰竭风险。在大量有风险的患者中，改善已被证明可预防心力衰竭的治疗方法的实施仍有很大机会。
