Gregg Fonarow, MD, of UCLA, discusses the vital importance of preventing HF in ways outside of just the available treatment options.
Gregg Fonarow, MD: Of course, we need an increased focus on preventing heart failure in the first place. It's phenomenal to have the advances we have for the sickest patients with advanced heart failure and we need to apply those therapies that can truly be life-saving, which is great, but our broader approach towards really benefitting the population health of those with heart failure by applying our guideline-recommended therapies is so critically important. It should be a major focus with anybody with an interest in heart failure. So prevention of heart failure is certainly critical.
Lifestyle plays an important role there, and behavioral change is among the most difficult things to achieve, but we have some things that can readily be done. Hypertension is a major risk factor for developing heart failure at every age, so more aggressive, appropriate, intensive management of systolic blood pressure can play a phenomenal role. Atherosclerotic cardiovascular disease plays a major role. There's still underutilization of statin therapy and high-intensity statin therapy for those with atherosclerotic cardiovascular disease, as well as those at risk, despite being widely available, well tolerated, and having benefits that greatly outweigh the risks, and being available generically for $40 a year.
We also recognize that, in fact, regular physical exercise can be important, so building healthier cities I completely agree with. Diabetes is a major risk factor for heart failure and there's now a remarkable therapy that doesn't just lower hemoglobin A1C for better glucose control, but actually dramatically lowers the risk of heart failure. But most endocrinologists don't use the therapy, and most patients with diabetes are not yet on this therapy even though it distinguishes itself from most diabetes medications in that this one can truly prevent heart failure: the sodium glucose co-transporter inhibitors. So there have been a number of therapeutic advances in prevention of heart failure, but getting that translated into population health benefits is a critical challenge that I think everybody that's involved in the care of heart failure should be involved with because they can see the consequences a real concerted effort to try and prevent heart failure.