Heart Failure Prevention: The Best Time to Start Is Years Before Symptoms

Heart failure prevention: it's never too late to start.

Heart failure is a common cause of hospitalization. This is particularly true for older individuals. It affects men and women of all racial and ethnic backgrounds, although the risk is higher in some populations. But is heart failure preventable? In many cases, we can substantially reduce the risk. To understand how, we first need to understand what causes heart failure.

Heart failure is defined as a clinical syndrome caused by structural or functional abnormalities of the heart that impair ventricular filling or ejection, producing symptoms and signs.

This means that heart failure can occur when the heart muscle is too weak to pump normally, but it can also occur when the pumping strength is relatively preserved, but the heart does not relax and fill normally, causing pressure to build up inside the heart and lungs.

The former is called heart failure with reduced ejection fraction, and the latter is called heart failure with preserved ejection fraction. The causes of these syndromes differ somewhat, but there is a broad area of overlap. This overlap makes the prevention of heart failure somewhat easier.

One of the major causes of heart failure, particularly heart failure with reduced ejection fraction, is poor circulation to the heart muscle. This is called ischemic heart disease. This happens when the coronary arteries that supply the heart muscle become narrowed or blocked by atherosclerosis.

As a result, the heart muscle essentially becomes starved of blood. Eventually, the muscle weakens and cannot perform its function properly. We can reduce the risk of these arteries becoming narrowed or blocked by paying attention to our diets, getting adequate exercise, not smoking, maintaining a healthy weight, and controlling blood pressure, cholesterol, and blood sugar.

Another major modifiable risk factor for heart failure is hypertension. While it is true that hypertension is not entirely under our control, we can take steps to prevent and control it. Here again, controlling our weight through our diet and exercise can contribute significantly to preventing hypertension.

Reducing excessive sodium intake can also help control blood pressure, particularly in people who are salt-sensitive If we develop hypertension, we should make controlling our blood pressure a priority by ensuring that we take our medications regularly, get enough exercise, and control our body weight.

Another important group of risk factors for heart failure includes type 2 diabetes and metabolic syndrome. Once again, type 2 diabetes is not entirely under our control, but we can reduce our chances of developing diabetes through weight management and exercise.

For people who already have diabetes, taking their medications as prescribed and controlling blood sugar, blood pressure, cholesterol, and body weight can help reduce cardiovascular risk. Some newer diabetes medications, particularly drugs known as SGLT2 inhibitors, can reduce the risk of hospitalization for heart failure.

Heart failure often develops after years of damage from conditions such as high blood pressure, coronary artery disease, diabetes, and obesity. Addressing these problems early gives us an opportunity to protect the heart long before the symptoms of heart failure ever appear.