New strategies and therapies for the prevention of heart failure in high-risk patients.
New strategies and therapies for the prevention of heart failure in high-risk patients.
复制标题
DOI：
10.1002/clc.23839
复制
发表时间：
2022-06
影响因子：
2.7
通讯作者：
中科院分区：
文献类型：
--
作者：
尽管美国的心血管疾病总死亡率有所下降，但心力衰竭（HF）死亡率以及住院和再入院率在过去十年中有所增加。青壮年和中年人（<65岁）的增加相对较高。因此，迫切需要在出现明显临床体征和症状（C期）之前识别HF高危（A期）或HF前期（B期）个体。多变量风险模型（例如，预防心力衰竭的合并队列方程[PCP‐HF]）已经在不同人群中进行了外部验证，并得到了2022年心力衰竭指南的认可，以应用基于风险的框架来预防心力衰竭。然而，PCP - HF模型中包含的传统危险因素仅占个人一生HF风险的一半；新的风险因素（如不良妊娠结局、肺部健康受损、COVID - 19）正在成为重要的风险增强因素，需要在个性化预防方法中加以考虑。除了确定新的风险增强因素的作用外，还需要整合健康社会决定因素（SDoH）来识别和解决HF风险，以改变目前预防HF的临床模式。预防心衰进展的综合策略必须包括药物治疗（例如，葡萄糖共转运蛋白2钠抑制剂，也被称为预防心衰的“他汀类药物”）、强化降压和心脏健康行为。未来的方向包括研究利用机器学习的新型预测模型，整合风险增强因素和SDoH，以及基于风险预防心衰的公平干预方法。
Despite declines in total cardiovascular mortality rates in the United States, heart failure (HF) mortality rates as well as hospitalizations and readmissions have increased in the past decade. Increases have been relatively higher among young and middle‐aged adults (<65 years). Therefore, identification of individuals HF at‐risk (Stage A) or with pre‐HF (Stage B) before the onset of overt clinical signs and symptoms (Stage C) is urgently needed. Multivariate risk models (e.g., Pooled Cohort Equations to Prevent Heart Failure [PCP‐HF]) have been externally validated in diverse populations and endorsed by the 2022 HF Guidelines to apply a risk‐based framework for the prevention of HF. However, traditional risk factors included in the PCP‐HF model only account for half of an individual's lifetime risk of HF; novel risk factors (e.g., adverse pregnancy outcomes, impaired lung health, COVID‐19) are emerging as important risk‐enhancing factors that need to be accounted for in personalized approaches to prevention. In addition to determining the role of novel risk‐enhancing factors, integration of social determinants of health (SDoH) in identifying and addressing HF risk is needed to transform the current clinical paradigm for the prevention of HF. Comprehensive strategies to prevent the progression of HF must incorporate pharmacotherapies (e.g., sodium glucose co‐transporter‐2 inhibitors that have also been termed the “statins” of HF prevention), intensive blood pressure lowering, and heart‐healthy behaviors. Future directions include investigation of novel prediction models leveraging machine learning, integration of risk‐enhancing factors and SDoH, and equitable approaches to interventions for risk‐based prevention of HF.
登录
查看更多内容
影响因子：
20.1
作者：
Ambale-Venkatesh B;Yang X;Wu CO;Liu K;Hundley WG;McClelland R;Gomes AS;Folsom AR;Shea S;Guallar E;Bluemke DA;Lima JAC
通讯作者：
Lima JAC
影响因子：
7.4
作者：
Cresci, Sharon;Pereira, Naveen L.;Wolf, Matthew J.
通讯作者：
Wolf, Matthew J.
影响因子：
158.5
作者：
Cleland, JGF;Daubert, J;Khan, NK
通讯作者：
Khan, NK
影响因子：
37.8
作者：
Shah AM;Claggett B;Loehr LR;Chang PP;Matsushita K;Kitzman D;Konety S;Kucharska-Newton A;Sueta CA;Mosley TH;Wright JD;Coresh J;Heiss G;Folsom AR;Solomon SD
通讯作者：
Solomon SD
影响因子：
13
作者：
Aimo, Alberto;Vergaro, Giuseppe;Emdin, Michele
通讯作者：
Emdin, Michele