March 5, 2024

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Two European associations issued a statement on the prevention of heart failure!

Two European associations issued a statement on the prevention of heart failure!


Two European associations issued a statement on the prevention of heart failure!.  4 types of drugs can prevent heart failure.

Heart failure is the last battlefield of various heart diseases. With the aging of the population, the prevalence of heart failure will worsen. How to stop the spread of heart failure, reduce the readmission rate of heart failure patients, and reduce the population and socioeconomic burden?


Recently, the European Heart Failure Association and the European Society for the Prevention of Cardiology jointly issued a position statement on heart failure prevention.


Two European associations issued a statement on the prevention of heart failure!


The statement pointed out several important issues to be aware of in life.




What you should pay attention on diet


The statement states that the diet should be low in 4: low-fat, low-sugar, low-salt and low-alcohol.


  • Low-fat : keep a low percentage of saturated fat (< 10% of total energy intake) and low trans fatty acids (as little as possible);
  • Low-sugar : sugar-sweetened beverages should not be consumed;
  • Low salt : < 5 g daily;
  • Low alcohol consumption: alcohol intake is less than 20 g/day for men and less than 10 g/day for women, it is best not to drink alcohol.


At the same time, maintain a healthy diet rich in whole grains, vegetables, fruits and fish; daily intake of both fruits and vegetables is ≥ 200 g; eat fish 1 to 2 times a week; eat 30 g of unsalted nuts per day.




Low alcohol consumption also increases heart failure risk


Excessive drinking can cause alcoholic cardiomyopathy, with an estimated 40% of dilated cardiomyopathy attributable to excessive drinking.


Alcoholic cardiomyopathy should be suspected if heavy drinking is present and ventricular dilatation is present. Common in men aged 30 to 55 years with a history of alcoholism > 10 years. Patients with recovery of left ventricular function after alcohol withdrawal have a better prognosis.


It was previously thought that light drinking could prevent heart failure, but this notion has been questioned. A large study of more than 500,000 people found that consuming >40 g of alcohol daily for more than 5 years was associated with an increased risk of heart failure.


In general, to prevent heart failure, we should drink lightly or even abstain from alcohol.




4 types of drugs can prevent heart failure


The article pointed out that there are 4 types of drugs that have the effect of preventing heart failure.


Meta -analysis found that, compared with placebo, diuretics, ACE/ARB were the most effective in preventing heart failure. The degree of blood pressure reduction is a major factor in the prevention of heart failure, but beta-blockers do not appear to prevent heart failure.


Sodium – glucose cotransporter- 2 inhibitors ( SGLT2i ) , such as empagliflozin, canagliflozin, dapagliflozin, and epagliflozin, reduce the risk of heart failure hospitalization. The role of DPP-4 inhibitors and GLP-1 receptor agonists in preventing heart failure is unclear.


Statins reduce cardiovascular events in patients without prior cardiovascular disease and slow the progression of heart failure, with net benefits proportional to baseline cardiovascular risk and lipid levels.



Smoking increases heart failure risk


Smoking is a potent and modifiable risk factor for cardiovascular disease. Several studies have confirmed that smoking is associated with a higher risk of heart failure.


In the Women’s Health Study, never smokers had a 57% reduction in the adjusted risk of heart failure events compared with current smokers and a 53% reduction in past smoking .


Smoking can indirectly affect heart structure and function, such as ischemic heart disease, and increase the risk of heart failure. Smokers had greater left ventricular weight and poorer heart function than non-smokers.


Meta – analysis also showed that continued smoking after a diagnosis of heart failure was associated with a 38% increased risk of death and a 45% increased risk of readmission .



Air pollution linked to heart failure

According to WHO data, more than 20% of cardiovascular deaths are caused by air pollution; there is increasing evidence that there is a dose-response relationship between long-term exposure to air pollution and heart failure.




Women more prone to diastolic heart failure

Men are more prone to systolic heart failure and women are more prone to diastolic heart failure. Women are more susceptible to diabetes, obesity, high blood pressure and smoking.

Perinatal cardiomyopathy often occurs in the last month of pregnancy or a few months after childbirth, with an incidence of about 1 in 10,000. Women are also affected by factors such as pregnancy-related disorders (eg, preeclampsia), mode of delivery, and genetic susceptibility.




The latest recommendations of relevant European societies


Globally, the leading cause of heart failure is ischemic heart disease, followed by hypertensive heart disease (predominantly in people aged 25-69) and chronic obstructive pulmonary disease.

The article points out that modifiable risk factors play an important role in promoting the development of heart failure, and comprehensive improvement of these factors is essential to prevent heart failure. In addition, comorbidities are also important contributing factors to heart failure.


Regarding various interventions that can improve risk factors, the article again recommends the latest recommendations of relevant European societies. The details are as follows:


1) Smoking: Any form of tobacco exposure should be avoided, and smokers can take nicotine replacement therapy;

2) Less sedentary, more exercise;

3) Maintain a healthy weight: Maintaining a healthy weight is very important. Studies have shown that every 1 kg/m² increase in the risk of heart failure by 5% to 7%.

4) Blood pressure: keep < 140/90 mmHg;

5) Manage blood lipids: maintain a healthy diet, and apply statins or other lipid-lowering drugs according to the situation;

6) Manage blood sugar: diabetic patients keep glycosylated hemoglobin < 7%; adhere to a healthy lifestyle; diabetic patients can choose SGLT2 inhibitors;

7) A variety of endocrine diseases may be related to heart failure. The etiological treatment of these reversible factors may provide the possibility for heart failure prevention:

For example, hypothyroidism can lead to left ventricular diastolic dysfunction and reduce cardiac output; while hyperfunction can lead to tachyarrhythmias, hypertension, left ventricular hypertrophy, left ventricular diastolic dysfunction, etc.;

8) Taking cardiotoxic drugs (such as anabolic steroids) requires monitoring;

9) Radiotherapy and chemotherapy: It is necessary to optimize the dose of chemotherapy drugs and monitor adverse reactions; optimize the dose and positioning of chest radiotherapy;

10) Virus infection: regular injection of influenza vaccine, early diagnosis and early treatment;

11) Infection (such as rheumatic heart disease, etc.): early diagnosis, and application of specific drugs for prevention and treatment;

12) Sleep apnea: continuous positive pressure airway ventilation for people over 60 years old with obstructive symptoms;

13) For environmental and air pollution: minimize exposure;

14) Hypertension during pregnancy: early diagnosis and early treatment.

In a word, everyone is the first responsible person for health, and protecting heart health must start with a healthy lifestyle.





[1] Preventing heart failure: a position paper of the Heart Failure Association in collaboration with the European Association of Preventive Cardiology. European Journal of Heart Failure. 2022;24:143–168.
[2] Heart Failure Expert Working Group of the National Cardiovascular Medical Quality Control Center Expert Committee. 2020 China Heart Failure Medical Quality Control Report. Chinese Journal of Circulation, 2021,36: 221-238.

Two European associations issued a statement on the prevention of heart failure!.  4 types of drugs can prevent heart failure.

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