Palazzuoli Alberto, Ruocco Gaetano, Gronda Edoardo
Cardiovascular Diseases Unit, Department of Internal Medicine, Le Scotte Hospital, University of Siena, 53100, Siena, Italy.
Cardiology Unit, Regina Montis Regalis Hospital, ASL-CN1, Mondovì, Cuneo, Italy.
Heart Fail Rev. 2022 May;27(3):767-778. doi: 10.1007/s10741-020-09972-6.
Heart failure is associated with a range of comorbidities that have the potential to impair both quality of life and clinical outcome. Unfortunately, noncardiac diseases are underrepresented in large randomized clinical trials, and their management remains poorly understood. In clinical practice, the prevalence of comorbidities in heart failure is high. Although the prognostic impact of comorbidities is well known, their prevalence and impact in specific heart failure settings have been overlooked. Many studies have described specific single noncardiac conditions, but few have examined their overall burden and grading in patients with multiple comorbidities. The risk of comorbidities in patients with heart failure rises with more advanced disease, older age, and increased frailty-three conditions that are poorly represented in clinical trials. The pathogenic links between comorbidities and heart failure involve many pathways and include neurohormonal overdrive, inflammatory activation, oxidative stress, and endothelial dysfunction. Such interactions may worsen prognoses, but details of these relationships are still under investigation. We propose a shift from cardiac-focused care to a more systemic approach that considers all noncardiac diseases and related medications. Some new drugs class such as ARNI or SGLT2 inhibitors could change prognosis by acting directly or indirectly on metabolic disorders and related vascular consequences.
心力衰竭与一系列共病相关，这些共病有可能损害生活质量和临床结局。不幸的是，非心脏疾病在大型随机临床试验中的代表性不足，对其管理仍知之甚少。在临床实践中，心力衰竭中共病的患病率很高。尽管共病对预后的影响众所周知，但它们在特定心力衰竭情况下的患病率和影响却被忽视了。许多研究描述了特定的单一非心脏疾病，但很少有研究考察它们在患有多种共病患者中的总体负担和分级。心力衰竭患者中共病的风险随着疾病进展、年龄增长和虚弱程度增加而上升，而这三种情况在临床试验中的代表性不足。共病与心力衰竭之间的致病联系涉及许多途径，包括神经激素过度激活、炎症激活、氧化应激和内皮功能障碍。这种相互作用可能会使预后恶化，但这些关系的细节仍在研究中。我们建议从以心脏为中心的治疗转向更全面的方法，考虑所有非心脏疾病和相关药物。一些新型药物类别，如ARNI或SGLT2抑制剂，可以通过直接或间接作用于代谢紊乱和相关血管后果来改变预后。
