From the Guidelines
Heart failure is primarily caused by coronary artery disease, hypertension, and dilated cardiomyopathy, which are responsible for a substantial proportion of cases in the Western world. These conditions can lead to impaired left ventricular (LV) myocardial function, resulting in the clinical syndrome of heart failure 1. The causes of heart failure can be diverse, including:
- Coronary artery disease, which restricts blood flow to the heart muscle
- Hypertension, which forces the heart to work harder until it weakens over time
- Dilated cardiomyopathy, which can have a genetic cause in up to 30% of patients
- Valvular heart disease, which disrupts normal blood flow through the heart
- Other significant causes, such as congenital heart defects, arrhythmias, and viral infections that inflame the heart
It is essential to note that heart failure is not equivalent to cardiomyopathy or LV dysfunction, but rather a clinical syndrome characterized by specific symptoms, such as dyspnea and fatigue, and signs, such as edema and rales 1. A careful history and physical examination are crucial for diagnosing heart failure, as there is no single diagnostic test for the condition 1. Understanding the causes of heart failure is vital for developing effective prevention strategies, which include managing blood pressure and cholesterol, maintaining a healthy weight, avoiding tobacco and excessive alcohol, and controlling diabetes.
From the FDA Drug Label
The etiology of heart failure was ischemic in 55%, and non-ischemic in 45% There was a history of myocardial infarction in 28%, of hypertension in 24%, and of diabetes in 22%.
The causes of heart failure include:
- Ischemic heart disease (55% of cases)
- Non-ischemic heart disease (45% of cases) Other contributing factors may include:
- Myocardial infarction (28% of patients)
- Hypertension (24% of patients)
- Diabetes (22% of patients) 2
From the Research
Causes of Heart Failure
The causes of heart failure are complex and multifaceted. Some of the common antecedents to heart failure include:
- Hypertension
- Diabetes mellitus
- Coronary artery disease 3 These conditions can lead to impaired ventricular contractility and/or relaxation, resulting in heart failure.
Pathogenic Mechanisms
The main pathogenic mechanisms involved in heart failure include:
- Sympathetic nervous system activation
- Renin-angiotensin-aldosterone system activation
- Inflammation 3 These mechanisms can contribute to the progression of heart failure and worsen its symptoms.
Role of Hypertension
Hypertension is a major modifiable risk factor for coronary artery disease (CAD) and heart failure 4, 5. High blood pressure can cause physical damage to the blood vessels, leading to the development of atherosclerotic plaques and increasing the risk of CAD. Additionally, hypertension can lead to left ventricular hypertrophy and atherosclerotic narrowing of the epicardial coronaries, which can further increase the risk of heart failure.
Prevention and Treatment
Prevention of age-related increases in blood pressure and intensive treatment of established hypertension can help reduce the risk of heart failure and other cardiovascular diseases 5. Treatment strategies for heart failure often target neurohormonal systems, and nonpharmacologic interventions and self-care are also important in overall heart failure management 3.