de Oliveira Correia Eduardo Thadeu, Mechanick Jeffrey I, Dos Santos Barbetta Letícia Mara, Jorge Antonio José Lagoeiro, Mesquita Evandro Tinoco
Cardiovascular Disease Doctoral Program, Universidade Federal Fluminense, Niterói, Brazil.
Icahn School of Medicine at Mount Sinai, Zena and Michael A. Wiener Cardiovascular Institute/Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, New York, NY, USA.
Heart Fail Rev. 2023 Jan;28(1):47-61. doi: 10.1007/s10741-022-10233-x. Epub 2022 Apr 4.
Heart failure (HF) is a complex clinical syndrome, associated with high rates of mortality, hospitalization, and impairment of quality of life. Obesity and type 2 diabetes are major cardiometabolic drivers, represented as distinct stages of adiposity- and dysglycemia-based chronic disease (ABCD, DBCD), respectively, and leading to cardiometabolic-based chronic disease (CMBCD). This review focuses on one aspect of the CMBCD model: how ABCD and DBCD influence genesis and progression of HF phenotypes. Specifically, the relationships of ABCD and DBCD stages with structural and functional heart disease, HF risk, and outcomes in overt HF are detailed. Also, evidence-based lifestyle, pharmacological, and procedural interventions that promote or reverse cardiac remodeling and outcomes in individuals at risk or with HF are discussed. In summary, driver-based chronic disease models for individuals at risk or with HF can expose prevention targets for more comprehensive interventions to improve clinical outcomes. Future randomized trials that investigate structured lifestyle, pharmacological, and procedural therapies specifically tailored for the CMBCD model are needed to develop personalized care plans to decrease HF susceptibility and improve outcomes.
心力衰竭（HF）是一种复杂的临床综合征，与高死亡率、高住院率及生活质量受损相关。肥胖和2型糖尿病是主要的心脏代谢驱动因素，分别表现为基于肥胖和血糖异常的慢性疾病（ABCD、DBCD）的不同阶段，并导致基于心脏代谢的慢性疾病（CMBCD）。本综述聚焦于CMBCD模型的一个方面：ABCD和DBCD如何影响HF表型的发生和进展。具体而言，详细阐述了ABCD和DBCD阶段与结构性和功能性心脏病、HF风险以及显性HF结局之间的关系。此外，还讨论了基于证据的生活方式、药物和程序干预措施，这些措施可促进或逆转有HF风险或患有HF的个体的心脏重塑及结局。总之，针对有HF风险或患有HF的个体的基于驱动因素的慢性病模型可以揭示预防靶点，以便进行更全面的干预以改善临床结局。未来需要进行随机试验，研究专门为CMBCD模型量身定制的结构化生活方式、药物和程序疗法，以制定个性化护理计划，降低HF易感性并改善结局。
