Elsevier

Cardiology Clinics

Volume 25, Issue 4, November 2007, Pages 487-495
Cardiology Clinics

Heart Failure in the Twenty-First Century: Is it a Coronary Artery Disease or Hypertension Problem?

https://doi.org/10.1016/j.ccl.2007.08.010Get rights and content

Hypertension and coronary disease are major risk factors for the incidence and progression of heart failure. These two risk factors frequently coexist, and have additive and synergistic effects that promote both left ventricular remodeling and heart failure in the general population. The relative contributions of these two risk factors to heart failure burden in the community may vary based on age, gender, and race. In general, attribution of heart failure in the community to solely one of these two risk factors is inappropriate. Prevention of both hypertension and coronary disease is important for preventing heart failure in the twenty-first century.

Section snippets

Biological plausibility and mechanistic insights

Coronary atherosclerosis is the critical determinant of the clinical manifestations of CAD. The role of myocardial infarction as a major antecedent of heart failure has been established by several studies [9], [14], [15], [16]. Clinically silent coronary disease is widely prevalent both in the general population and in heart failure patients, as evidenced by coronary plaques found both in children and young adults in autopsy series [17] and in angiographic studies of healthy heart-transplant

Biological plausibility and mechanistic insights

Systemic blood pressure is determined by peripheral vascular resistance and conduit artery stiffness. The myocardium has to pump blood against the afterload posed by the resistance of peripheral vasculature and the stiffness of the large and medium-sized arteries. An elevated blood pressure places greater hemodynamic burden on the myocardium.

Elevated blood pressure leads to a compensatory increase in myocardial muscle mass to maintain normal cardiac output [58], [59]. In both hypertensive and

Discussion: Is this a reasonable debate?

Thus, persuasive arguments can be made to substantiate the claims that either CAD or hypertension may be key etiological risk factors for heart failure in the new millennium. But it is worth pondering if this is, in reality, a reasonable debate. Several issues have to be considered to ascertain the primacy of one risk factor over others. Hypertension and CAD frequently coexist. The two conditions also interact synergistically as risk factors for heart failure (see below). Also, the relative

Summary

Both hypertension and CAD are major risk factors for the onset and the progression of heart failure. They have additive and synergistic effects in the pathogenesis of the syndrome, and frequently coexist. With the aging of the population in developed countries and with onset of epidemiological transition of developing countries (to the stage of chronic degenerative diseases) [97], the prevalence of hypertension, CAD, and heart failure will likely rise worldwide over the next few decades.

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    This work was supported by NO1-HC-25195, K24 HL 04334 (RSV), from the National Heart, Lung and Blood Institute.

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