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Publications

Journal Article Ahead of print

PubMed: 42817848 DOI: 10.1093/ejhf/xuag301

Pharmacological treatment strategies to prevent heart failure across the cardiovascular-kidney-metabolic spectrum: an EJHF Expert Consensus Statement.

Eur J Heart Fail

Authors: Riccardo M Inciardi, Amr Abdin, Magdy Abdelhamid, Giuseppe Ambrosio, Michael Böhm, Antonio Cannata, Ovidiu Chioncel, Francesco Cosentino, Alberto Esteban-Fernandez, Ahmed Elsanhoury, Nicolas Girerd, Pardeep S Jhund, Felix Lindberg, Sophie Van Linthout, Carlo M Lombardi, Brendon L Neuen, John W Ostrominski, Davide Stolfo, Muthiah Vaduganathan, Scott D Solomon, Wilfried Mullens, Marco Metra, Gianluigi Savarese

Affiliations

  • Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
  • Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
  • Internal Medicine Clinic III, Cardiology, Angiology and Intensive Care Medicine, Saarland University Hospital, Homburg/Saar, Germany.
  • Faculty of Medicine, Kasr Al Ainy, Cardiology Department, Cairo University, Giza, Egypt.
  • Department of Cardiology, Universita degli Studi di Perugia, Perugia, Italy.
  • Italian National Institute for Cardiovascular Research - INRC, Bologna, Italy.
  • School of Cardiovascular Medicine and Sciences, King's College London, London, UK.
  • Emergency Institute for Cardiovascular Diseases "Prof Dr CC Iliescu", Bucharest, Romania.
  • Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
  • Division of Cardiology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
  • Cardiology Service, Hospital Universitario Severo Ochoa, Madrid; Facultad de Ciencias Biomédicas y de la Salud, Universidad Alfonso X el Sabio (UAX), Madrid, Spain.
  • Berlin Institute of Health (BIH), Center for Regenerative Therapies (BCRT), Charité-University Medicine Berlin, 13353 Berlin, Germany.
  • DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.
  • CHRU de Nancy, Université de Lorraine, Centre d'Investigation Clinique Plurithématique 1433, INSERM U1116 - DCAC, and F-CRIN INI-CRCT, Nancy, France.
  • British Heart Foundation Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom.
  • Deutsches Herzzentrum der Charité (DHZC), Department of Cardiology, Angiology and Intensive Care Medicine, Campus Virchow-Klinikum, Berlin, Germany.
  • The George Institute for Global Health, University of New South Wales, Sydney, Australia.
  • Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
  • Cardiothoracic Department, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC) and University Hospital of Udine, Udine, Italy.
  • Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.
  • Hasselt University, Hasselt, Belgium.
  • Cardiology. Vita-Salute San Raffaele University, IRCCS San Raffaele Hospital, Milan. Italy.
  • Cardiology. IRCCS San Raffaele Scientific Institute Milan Italy.

Abstract

Heart failure (HF) remains a major cause of morbidity, mortality, and increased healthcare costs worldwide, and is recognized as the result of progressive cardiovascular-kidney-metabolic (CKM) syndrome. Obesity, type 2 diabetes, chronic kidney disease, hypertension, and atherosclerotic cardiovascular disease frequently coexist and interact through shared pathophysiological mechanisms that promote HF onset, especially with preserved ejection fraction (HFpEF). This European Journal of Heart Failure (EJHF) Expert Consensus Statement synthesizes contemporary evidence supporting pharmacological strategies to prevent HF across the CKM spectrum. Foundational therapies, including renin-angiotensin system inhibitors, sodium-glucose cotransporter 2 inhibitors, non-steroidal mineralocorticoid receptor antagonists, and incretin-based agents, demonstrate complementary benefits in reducing HF events, cardiovascular death, and chronic kidney disease (CKD) progression in high-risk populations. Early, parallel initiation of these therapies may modify disease trajectory and attenuate progression from at-risk and pre-HF stages to overt clinical HF. This document further emphasizes the need for an up-front, accelerated implementation strategy supported by structured monitoring, multidisciplinary CKM care pathways, and proactive management of laboratory abnormalities. Overcoming barriers such as clinical inertia, safety misperceptions, polypharmacy, cost constraints, and inequities in access is essential to translate evidence into population-level impact. Harmonization of prevention frameworks across cardiology, nephrology, endocrinology, and primary care societies is urgently required. Integrated, cross-disciplinary implementation of evidence-based CKM management offers a realistic opportunity to reduce incident HF and mitigate its growing global burden.

MeSH

Kidney Diseases, Heart Failure, Heart, Kidney, Therapeutics