Circulation. 2006;114:1202-1213
doi: 10.1161/CIRCULATIONAHA.106.623199
doi: 10.1161/CIRCULATIONAHA.106.623199
(Circulation. 2006;114:1202-1213.)
© 2006 American Heart Association, Inc.
Contemporary Reviews in Cardiovascular Medicine |
Navigating the Crossroads of Coronary Artery Disease and Heart Failure
From Northwestern University Feinberg School of Medicine, Chicago, Ill (M.G., R.O.B.); National Heart, Lung, and Blood Institute, Bethesda, Md (G.S.); European Hospital, Rome, Italy (L.D.L.); Duke University Medical Center, Durham, NC (E.J.V.); Mount Sinai Hospital, Toronto, Ontario, Canada (J.D.P.); Ohio State University, Columbus (P.F.B.); National Institute of Cardiology, Warsaw, Poland (Z.S.); Medical University of Silesia, Katowice, Poland (K.S.G.); St Vincent’s Hospital, Melbourne, Victoria, Australia (D.L.P.); and Montreal Heart Institute, Montreal, Quebec, Canada (J.L.R.).
Correspondence to Robert O. Bonow, MD, Division of Cardiology, Northwestern University Feinberg School of Medicine, Galter 10-240, 201 E Huron St, Chicago, IL, 60611. E-mail r-bonow@northwestern.edu
Key Words: atherosclerosis • heart failure • surgery
An extract of the first 250 words of the full text is provided, because this article has no abstract. |
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Introduction |
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Chronic heart failure (HF) affects 5 million patients in the United States and is responsible for &1 million hospitalizations and 300 000 deaths annually.1 The total annual costs associated with this disorder have been estimated to exceed $40 billion.1,2 Chronic HF is the only category of cardiovascular diseases for which the prevalence, incidence, hospitalization rate, total burden of mortality, and costs have increased in the past 25 years.1,2 Fueling this epidemic is the increasing number of elderly patients developing impaired left ventricular (LV) function as a manifestation of chronic coronary artery disease (CAD).1,2 With the aging of the population and decline in mortality of other forms of cardiovascular diseases, it is likely that the incidence of HF and its impact on public health will continue to increase.1–3
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CAD and HF: Epidemiology and Prognosis |
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In the past 3 decades, considerable attention has focused on LV dysfunction, loading conditions, neuroendocrine activation, and ventricular remodeling as the principal pathophysiological mechanisms underlying HF progression.4 There has been a fundamental shift, however, in the origin of HF that often is underemphasized.3–5 The Framingham Heart Study suggests that the most common cause of HF is no longer hypertension or valvular heart disease, as it was in previous decades, but rather CAD.4
This shift may be related to improved survival of patients after acute myocardial infarction (MI). Over the past 40 years in the United States, the odds of previous MI as a cause for HF increased by 26% per decade in men and 48% per decade in women. In contrast, there has
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