Targeting Other Modifiable Risk Factors for the Prevention of Heart Failure: Diabetes, Smoking, Obesity, and Inactivity

Purpose of Review: Prevention and reduction of risk factors is imperative in the battle against the heart failure epidemic. In this report, we update prior reviews with a focus on the modifiable risk factors of diabetes, smoking, obesity, and inactivity with regard to epidemiology, pathophysiology, management, and therapeutic options. Recent Findings: While the incidence of diabetes is rising, recent trials suggest options for diabetic patients to prevent cardiovascular morbidity, mortality, and heart failure, with several more trials underway. We highlight several novel agents including sodium-glucose cotransporter-2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor antagonists. Tobacco smoking significantly increases the risk for heart failure, and recent data show early cessation may be beneficial. Education, support mechanisms, and weaning tools are useful, but some patients may benefit from behavioral counseling and even pharmacotherapy. Obesity is well recognized for its role in the development of heart failure and contributes to standard cardiovascular risk factors, left ventricular hypertrophy, sleep apnea, and metabolic syndrome. Lifestyle changes are vital to impacting this condition and thus rely heavily on patient motivation and compliance. Newer medications for assistance with weight loss have been approved, while bariatric surgery may be necessary for some. Specific effects of physical activity on heart failure prevention are not well delineated and may differ for patients with diabetes. Summary: Extensive efforts in patient education on self-management of their health, prevention and control of risk factors will be the ultimate solution to decreasing the incidence of heart failure in the future. © 2018, Springer Science+Business Media, LLC, part of Springer Nature.