Preventing Heart Failure: Updating Pharmacological and Lifestyle Interventions Across Cardiometabolic Risk Profiles

Article Impact Level: HIGH
Data Quality: STRONG
Summary of  European Heart Journal https://doi.org/10.1093/eurheartj/ehag362 
Dr. Massimo Piepoli  et al.

Points

European Heart Journal published the first comprehensive scientific statement dedicated to the primary and secondary prevention of heart failure across global populations.
Heart failure currently affects more than 60 million people worldwide and represents a leading cause of hospital admissions for adults aged 65 and older.
Prevention strategies focus on modifying major risk factors including hypertension, diabetes mellitus, obesity, dyslipidemia, chronic kidney disease, and physical inactivity.
Primary care physicians play a central role by identifying subclinical cardiac risk and managing chronic conditions long before overt heart failure symptoms develop.
Recent clinical evidence supports early pharmacological therapy alongside lifestyle interventions in high-risk patients with metabolic and renal disease to prevent progression.

Summary

Multidisciplinary strategies for the global prevention of heart failure (HF), addressing a clinical syndrome that currently affects more than 60 million individuals worldwide. While HF remains a major cause of morbidity and hospitalization, particularly among adults aged 65 and older, its epidemiology is shifting from ischemic coronary etiology toward metabolic, renal, and hypertensive drivers. Building upon the 2021 ESC Guidelines and the 2022 joint position paper, this expert statement synthesizes post-2022 clinical trial evidence to define tailored preventive paradigms across primary care and subspecialty settings.

The statement emphasizes early identification and aggressive management of modifiable cardiometabolic risk factors prior to overt symptom onset. Particular focus is directed at managing arterial hypertension, dyslipidemia, obesity, type 2 diabetes, and chronic kidney disease, alongside lifestyle modification and vaccination against cardiotropic infections. Furthermore, emerging evidence highlights the role of novel pharmacological agents, such as SGLT2 inhibitors and GLP-1 receptor agonists, which confer substantial primary protection against heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF) in high-risk metabolic cohorts.

The authors conclude that effective HF prevention requires an integrated, multidisciplinary care model centered in primary care to identify asymptomatic subclinical disease. By shifting focus from end-stage disease management toward early lifestyle, environmental, and pharmacological interventions, healthcare systems can reduce HF incidence, lower hospitalization burdens, and mitigate long-term cardiovascular mortality.

Link to the article: https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehag362/8698338?login=false

References

Piepoli, M., Rosano, G., Abreu, A., Adamo, M., Attanasio, A., Chioncel, O., Cohen-Solal, A., Filippatos, G., Gerdts, E., Gevaert, A., Halle, M., Jhund, P., Kurpas, D., Moura, B., Parati, G., Petrie, M. C., Shantsila, E., Simpson, M., Sudano, I., … Metra, M. (2026). Prevention of heart failure. European Heart Journal, ehag362. https://doi.org/10.1093/eurheartj/ehag362