Coronary artery disease and its progression are major contributors to the development and progression of left ventricular systolic dysfunction and HF. This progression does not require a discrete coronary event such as an acute myocardial infarction because chronic ischemia may contribute, as well. In addition, endothelial dysfunction may also lead to progression of myocardial dysfunction. Measures specifically targeting reduction in the risk of reinfarction and improvement in endothelial function may play an important role in blunting the progression of HF and in improving prognosis. Recognizing that coronary artery disease is a leading cause of HF in the United States is of critical importance if mortality from this condition is to be reduced. Although some patients may be candidates for mechanical revascularization (coronary artery bypass surgery or percutaneous coronary intervention) to improve left ventricular function, all patients are candidates for aggressive secondary prevention strategies (pharmacologic revascularization) designed to reduce progression of coronary artery disease.
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