Overview

Heart failure (HF) is an all-too-frequent outcome of hypertension and arterial vascular disease, making it a major public health concern.1,2 Epidemiologic, clinical, and basic research have identified a number of antecedent conditions that predispose individuals to HF and its predecessors, left ventricular (LV) remodeling and dysfunction.3-11 Recognition that many of these risk factors can be modified and that treating HF is difficult and costly has focused attention on preventive strategies for HF.

Development of both systolic and diastolic dysfunction related to adverse ventricular remodeling may take years to produce significant ill effects.12-18 Although the precise mechanisms for the transition to symptomatic HF are not clear, many modifiable factors have been identified that predispose or aggravate the remodeling process and the development of cardiac dysfunction. Treatment of systemic hypertension, with or without LV hypertrophy, reduces the development of HF.19-27 Prevention of myocardial infarction (MI) in patients with atherosclerotic cardiovascular disease is a critical intervention, since occurrence of MI confers an 8- to 10-fold increased risk for subsequent HF.20 Other modifiable risk factors include anemia, diabetes, hyperlipidemia, obesity, valvular abnormalities, alcohol, certain illicit drugs, some cardiotoxic medications, and diet.28,29 Consumption of one or more breakfast cereals per week and four or more servings of fruits and vegetables per day, as well as frequent exercise and moderate alcohol use have been individually and jointly associated with lower lifetime risk of HF in men.29