Cardiac remodeling at the population level--risk factors, screening, and outcomes.

The prevalence of heart failure is increasing in the western world. Current efforts aim to identify heart failure at its earliest and preclinical stages in order to begin treatment and prevent deterioration before the symptoms escalate. Cardiac remodeling is the process of structural and functional changes in the left ventricle in response to internal or external cardiovascular damage or influence by pathogenic risk factors, and is a precursor of clinical heart failure. Cardiac remodeling is classified as isolated cardiac hypertrophy or as hypertrophy in combination with left ventricular dilatation, and has been used as a surrogate end point in clinical trials. In this article, we review population-based studies of cardiac remodeling, providing insights into the associations between remodeling and risk factors such as age, sex, ethnicity, body stature and composition, and disease. We also highlight the importance of screening for subclinical heart failure and describe the strategies used to do so.