Drug therapy and heart failure prevention.

There are at least 5 million people in the United States living with chronic heart failure (CHF) today.1 Approximately 550 000 new cases of heart failure are identified in this country each year.1 In addition, there are tens of millions more people living with one or more risk factors for the development of heart failure, including coronary artery disease, hypertension, dyslipidemia, obesity, and diabetes, and these numbers are presently on the rise. Clinical research conducted over the last decade has focused primarily on enhancing treatment options for patients with known left ventricular (LV) dysfunction, with or without heart failure symptoms. Thanks to the treatments identified by such studies as Studies of Left Ventricular Dysfunction (SOLVD),2 Randomized Aldactone Evaluation Study (RALES),3 The Cardiac Insufficiency Bisoprolol Study II (CIBIS II),4 Metoprolol CR/XL Randomized Intervention Trial in Congestive Heart Failure (MERIT-HF),5 Carvedilol Prospective Randomized Cumulative Survival (COPERNICUS),6 and many others, the risk of morbidity and mortality after heart failure diagnosis has been substantially lowered, provided that patients with CHF are actually treated with inhibitors of the renin-angiotensin-aldosterone system and -blockers. In contrast, very little is known about what interventions can be utilized to improve and/or prolong the lives of the much larger and broader group of patients mentioned above, who are at risk of developing left ventricular dysfunction and CHF. Aside from appropriately treating prevailing conditions, what else, if anything, can be done to impact the future health status of these at-risk patients?