▎ WuXi AppTec content team editor
Heart failure, or heart failure for short, is a state in which the structure or function of the heart is abnormal, and is a severe and terminal stage of cardiovascular disease. Various cardiovascular diseases develop to a certain extent, which may lead to heart failure, such as coronary heart disease, myocarditis, abnormal heart structure, rapid or slow heart beat.
Heart failure not only has a high disability and mortality rate, but also increases as the population ages. According to the China Cardiovascular Health and Disease Report 2020, about 8.9 million people in China currently have heart failure; among adults aged 35 years and older, the prevalence of heart failure is about 1.3%, an increase of 44% from 0.9% in 2000.
For heart failure, how to prevent and delay the progression of the disease, and improve the quality of life and life of patients? Recently, the European Heart Failure Association and the European Association of Preventive Cardiology jointly issued a position statement on the prevention of heart failure in the European Journal of Heart Failure, which made suggestions for the prevention of heart failure. Today, we're sharing some of the highlights of the statement with our readers.
Screenshot from the European Journal of Heart Failure
The statement pointed out that modifiable risk factors, including blood pressure, blood glucose and lifestyle, play an important role in the occurrence and development of heart failure, and measures taken to effectively prevent heart failure, control the disease and delay the progression of the disease.
Control blood pressure
Hypertension is one of the most common modifiable risk factors for heart failure, and an increasing number of people with heart failure have a history of hypertension. Studies have found that 66% of people with heart failure have a history of hypertension between 1985 and 1990, and by 1997-2002, this proportion rose to 74%.
People with high blood pressure have a much higher risk of developing heart failure than people with normal blood pressure, and controlling blood pressure helps reduce the risk. Studies have found that long-term treatment of high blood pressure can reduce the risk of heart failure by about 50%, and the risk of death from heart failure will also be reduced.
The statement recommends that medication should be taken under the guidance of medical staff, combined with a healthy lifestyle, to control blood pressure within the normal range and reduce the risk of heart failure and development.
Image credit: 123RF
Treatment of diabetes
Heart failure is one of the most common cardiovascular complications of type 2 diabetes. Studies have found that among the first cardiovascular complications that occur in patients with type 2 diabetes, in addition to the most common peripheral arterial disease, followed by heart failure.
People with type 2 diabetes also have a higher risk of heart failure. Studies have shown that people with type 2 diabetes have a 56% higher risk of developing heart failure compared to people who do not have type 2 diabetes.
The statement pointed out that treating type 2 diabetes has become a feasible strategy to prevent the development of heart failure. The use of drugs such as sodium-glucose synergistic transporter 2 (SGLT-2) inhibitors to treat type 2 diabetes mellitus should also be combined with a healthy lifestyle to control blood glucose and prevent cardiovascular complications such as heart failure.
Reduce sedentary behavior
There is evidence that people who are regularly physically active have a significantly lower risk of heart failure compared with people who spend more time sedentary and less physically active, and that the risk decreases gradually with increased physical activity.
The Women's Health Initiative study showed that the incidence of heart failure was 2.15 per 1000 person-years for people who were regularly physically active (> 150 minutes of moderate-intensity physical activity per week, or >75 minutes of high-intensity physical activity), compared with 3.29/1000 person-years for those who were not physically active.
The statement suggests that moving more and sitting less will help prevent the occurrence and development of heart failure.
Control weight
The risk of developing heart failure is related to weight. It is estimated that for every 1 kg/m2 increase in body mass index (BMI), the risk of developing heart failure increases by 5% to 7%.
In addition, studies have shown that people with a BMI of> 30 kg/m2 and BMI between 25 kg/m2 and BMI of 25 kg/m2 and 25 kg/m2 have a 50% lower risk of heart failure, respectively, compared with those with a BMI of 30 kg/m2 and a BMI of 25 kg/m2-30 kg/m2, respectively.
The statement recommends reducing energy intake and increasing energy expenditure to control weight and maintain bMI within healthy ranges by increasing physical activity and healthy eating.
Healthy eating
The statement recommends that the daily diet should be low in fat, sugar and salt to prevent the occurrence and development of heart failure. Specifically:
Replace saturated fatty acids with polyunsaturated fatty acids and reduce saturated fatty acid intake so that their proportion of total energy intake does not exceed 10%;
Reduce your intake of trans fatty acids as much as possible so that they do not exceed 1% of your total energy intake, and avoid intake from processed foods, preferably from natural sources, such as meat;
Limit the use of sugary drinks, preferably not;
Eat no more than 5 g of salt per day;
Increase consumption of whole grains, fresh fruits and vegetables, fish and nuts by 30 g-45 g of dietary fiber per day, preferably from whole grains; ≥ 200 g of fruit per day; ≥ 200 g of vegetables per day; 30 g of unsalted nuts per day; eat fish 1-2 times a week, at least 1 of which is oily fish.
Do not drink alcohol
Excessive alcohol consumption is one of the most important causes of dilated cardiomyopathy (ACM). It is estimated that 40% of dilated cardiomyopathy can be attributed to excessive alcohol consumption. Dilated cardiomyopathy often occurs in men aged 30 to 55 years with a 10-year history of alcoholism, with a poor prognosis and a 5-year survival rate of about 50%.
In addition, a large-scale study of more than 500,000 people found that consuming more than 40 g (about 2.5-3 cups) of alcohol per day for more than 5 years was associated with a higher risk of heart failure.
The statement recommends that alcohol intake should be limited to the levels recommended in many current guidelines (no more than 1 cup per day for women and no more than 2 cups per day for men), and it is best not to drink alcohol, especially in patients with dilated cardiomyopathy.
Non-smoking
Smoking is a strong, modifiable risk factor for cardiovascular disease. Multiple studies have shown that smoking is associated with a higher risk of developing heart failure.
The Women's Health Initiative study showed that people who never smoked had a 57 percent lower risk of heart failure compared to those who currently smoked; those who quit smoking had a 53 percent lower risk of heart failure. In addition, studies have shown that continued smoking after heart failure is associated with a 38% increased risk of death and a 45% increased risk of re-hospitalization.
The statement suggested that in order to prevent the occurrence and development of heart failure, smokers, whether smoking cigarettes, shisha or electronic cigarettes, should quit smoking as soon as possible.
Prevent viral infections
The inflammatory response triggered by a viral infection of the heart may cause viral myocarditis, which in turn can lead to heart failure. Common viruses that cause myocarditis are upper respiratory tract virus, enterovirus, human parvovirus B19, human herpesvirus-4, and human herpesvirus-6.
The statement recommends that regular vaccination of influenza vaccines or other means to prevent viral infections, and timely treatment of diseases caused by infections, can help prevent the occurrence and development of heart failure.
Monitor the effectiveness of radiation therapy and chemotherapy
Cancer treatment modalities such as radiation therapy and chemotherapy, especially chest radiation therapy, can cause damage to the heart and increase the risk of heart failure.
The statement recommends that cardiotoxic chemotherapy drugs should be monitored in cancer treatment, while optimizing the dose of chemotherapeutic drugs, chest radiotherapy doses and positioning; and regular follow-up after treatment to reduce the risk of heart failure.
Take the relevant medications
The statement recommends that under the guidance of medical staff, diuretics, angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor antagonists (ARBs), statins, sodium-glucose synergistic transporter 2 (SGLT-2) inhibitors, etc., are taken to control blood pressure or blood sugar, and also help prevent the occurrence and development of heart failure.
In addition, the statement also pointed out that rheumatic heart disease, sleep apnea syndrome, thyroid disease and other endocrine diseases, etc., will also increase the risk of heart failure and development, people with these diseases, to seek medical treatment in time to avoid the occurrence and aggravation of heart failure.
brief summary
Taken together, the incidence of heart failure is increasing globally, which means that if preventive measures are not taken, more people will suffer from heart failure, increasing the risk of death. But at the same time, people can take some preventive measures to reduce the risk of heart failure, control or delay the progression of the disease, and improve the quality of life and life.
For the sake of health and life safety, we hope that we can make changes, take preventive measures, change risk factors, reduce the risk of heart failure, and improve health.