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U-shape relationship in heart failure?

Heart Failure Congress 2013 - Session report

Session number: 101
Session title: U-shape relationship in heart failure?
Authors: Ulrich Laufs (Homburg, Germany)

Heart Failure (HF)

Recent epidemiological observations and interventional studies have shown that the relationship between several risk factors and outcomes in chronic heart failure is not linear, but in fact may be U-shaped, suggesting that detrimental effects may be observed on both sides of “optimal” risk factor modulation.

In today’s session, G Bakris from Chicago explained the new Joint National Committee (JNC) 2013 recommendations for blood pressure goals <140/90 mmHg, and <150/90 mmHg for individuals >60 years of age. 

AL Clark from Kingston-Upon-Hull, in a provocative lecture called HbA1c a fat “red herring” that confuses surrogate laboratory values with clinical events. He suggested “not to measure it” and “not to treat it”. However, in a lively discussion this point of view was disputed. 

S von Haehling (Berlin) explained the U-shaped epidemiology of body weight and CHF. In individuals >70 years of age, no increase in mortality is associated with high body weight, only low BMI had a negative association with mortality. For patients with CHF, the “optimal” BMI is 28-32, however, only limited data are available for individuals with BMI >35. He presented unpublished DEXA scan studies that showed that body fat content correlates with lower mortality in CHF.

I Pina, Bronx, USA, reviewed the complex data on salt consumption and CV events. Her summary was that no clear evidence supports strict recommendations for sodium restrictions in CHF patients. Flexible diuretic regimens are needed to avoid fluid depletion.

AP Maggioni from Florence discussed the data showing that LDL-lowering by statins reduced the risk of myocardial infarction in primary and secondary prevention. However, in CHF, higher serum cholesterol is not negative, and the CORONA and GISSI-HF trials showed no mortality benefit of statins in CHF patients. Therefore, statins are not indicated for CHF. However, ongoing statin therapy after a recent myocardial infarction should not be discontinued. 

Finally, S Rosenkranz from Cologne presented epidemiologic and novel experimental research supporting beneficial effects of red wine contents, derived from mash fermentation of grape skins and seeds (polyphenols, catechins, flavonoids). 

All authors pointed out the need for further research and the need to re-think common recommendations on risk factor management in CHF.

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.