Overview of the relationship between ischemia and congestive heart failure

Ischemic heart disease is the principal etiology of heart failure in the We stern world. Myocardial ischemia is important in cardiac remodeling, a proc ess that leads to a progressive change in the shape and size of the heart a nd significantly worsens the prognosis of patients with heart failure. Prev enting ischemic events, therefore, is an important goal in the management o f patients with coronary artery disease. Statins have been shown to reduce the number of ischemic events in these patients, whereas the benefit of bet a-blocker and aldosterone antagonist therapy on ischemic causes of heart fa ilure remains unclear. Several large trials involving patients with asympto matic left ventricular dysfunction after myocardial infarction or heart fai lure have shown that angiotensin-converting enzyme (ACE) inhibitors reduce the incidence of progressive heart failure, death, and ischemic events, thu s establishing ACE inhibitors as first-line therapy for these patients. Oth er lines of evidence have suggested that ACE inhibitor therapy may also ben efit patients with preserved left ventricular function, a hypothesis that i s being evaluated in three large, controlled, randomized trials. One of the se trials, the Heart Outcomes Prevention Evaluation (HOPE) study, was termi nated prematurely because it demonstrated the significant positive effects of the ACE inhibitor ramipril on cardiovascular outcomes in patients with c oronary artery disease and preserved left ventricular function. A growing b ody of data confirms the relationship between ischemia and heart failure an d the benefits of ACE inhibitor treatment in abroad range of high-risk pati ents.