Pharmacological treatment strategies to prevent heart failure across the cardiovascular-kidney-metabolic spectrum: an European Journal of Heart Failure (EJHF) Expert Consensus Statement

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 heart failure (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.

Up-front, accelerated implementation strategy supported by structured monitoring, multidisciplinary cardiovascular-kidney-metabolic (CKM) care pathways, and proactive management of laboratory abnormalities is needed.

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.