Prevent heart failure before symptoms start: New ESC statement shifts care upstream

Clinical takeaway: Identify patients with clustered hypertension, diabetes, obesity, and chronic kidney disease before symptoms develop, then combine intensive risk-factor control with evidence-based therapies—especially SGLT2 inhibitors and, when appropriate, finerenone or GLP-1 receptor agonists—to reduce future heart failure risk.

A new multisociety scientific statement from the European Society of Cardiology reframes heart failure as a condition that should be prevented years before dyspnea, edema, or ventricular dysfunction emerges. The authors recommend a multidisciplinary, individualized approach addressing cardiovascular-kidney-metabolic risk alongside lifestyle, environmental, reproductive, infectious, and socioeconomic contributors.

For hypertension, clinicians should generally target blood pressure of 120–129/70–79 mmHg, while individualizing treatment for frailty, orthostatic hypotension, limited life expectancy, and adults older than 85. Thiazide diuretics, ACE inhibitors or ARBs, beta-blockers, and calcium channel blockers remain options; non-dihydropyridine calcium channel blockers may be less effective for heart failure prevention than other classes.

In type 2 diabetes, drug selection matters beyond glycemic control. SGLT2 inhibitors are identified as the preferred drugs for preventing heart failure in patients with cardiovascular risk, established atherosclerotic disease, or chronic kidney disease. GLP-1 receptor agonists improve cardiovascular outcomes and may modestly reduce heart failure hospitalization, although their preventive effect is less certain than that of SGLT2 inhibitors. Avoid saxagliptin in patients at risk for heart failure; thiazolidinediones may also be harmful because of fluid retention.

For diabetes with chronic kidney disease, clinicians should optimize ACE inhibitor or ARB therapy when hypertension and albuminuria are present. SGLT2 inhibitors reduce kidney disease progression and cardiovascular death or heart failure hospitalization. Finerenone is indicated for persistent albuminuria despite standard therapy when kidney function and potassium levels permit. Semaglutide may also reduce heart failure events in patients with diabetes and chronic kidney disease.

The statement also supports structured exercise, healthy weight, smoking cessation, limiting alcohol, vaccination, and assessment of reproductive history, cancer-treatment exposure, air pollution, food insecurity, and social isolation. Natriuretic peptide–based screening followed by team-based care may help prevent ventricular dysfunction or new-onset heart failure in high-risk patients.

What’s changed

• Updates the 2022 ESC position paper with stronger evidence for prevention in metabolic disease and chronic kidney disease.
• Elevates SGLT2 inhibitors as central preventive therapy in high-risk type 2 diabetes and diabetic kidney disease.
• Incorporates newer evidence for finerenone and semaglutide.
• Adds SCORE2-HF and broader attention to female-specific, environmental, infectious, and socioeconomic risks.

“Heart health is built every day—at the dining table, during a walk, in the family physician’s office, and through routine examinations performed long before any symptoms become apparent,” the authors emphasized.

Source: Piepoli M, et al. (2026 May 30) Eur Heart J. Prevention of heart failure: A scientific statement of the Heart Failure Association, the European Association of Preventive Cardiology, and the Association of Cardiovascular Nursing & Allied Professions of the ESC, and the ESC Council on Hypertension