Heart failure with preserved and reduced ejection fraction: different risk profiles for different diseases

Abstract

This editorial refers to ‘Incidence and epidemiology of new onset heart failure with preserved vs. reduced ejection fraction in a community-based cohort: 11-year follow-up of PREVEND’, by F.P. Brouwers et al. , doi:10.1093/eurheartj/eht066 Approximately 15 million Europeans and 6 million Americans suffer from heart failure (HF), with annual direct and indirect costs in the billions.1 About half of patients have a preserved ejection fraction (HFpEF), while the others display a reduced EF (HFrEF).2,3 Clinical trials have unequivocally shown that treatments such as neurohormonal antagonists improve outcome in HFrEF, while similar trials in HFpEF have been neutral.1,2 Several reasons have been proposed for this differential response, including unique pathophysiologies in HFpEF and HFrEF, differing degrees of neurohormonal activation, significant pathophysiological heterogeneity within the broad population of HFpEF patients, and higher non-cardiovascular mortality in HFpEF.1,2 It is also possible that the heart in HFrEF displays greater plasticity and amenability to reverse remodelling, while changes in the mechanical properties of the heart and vasculature in HFpEF might be less reversible by the time symptoms develop. Thus, interventions designed to prevent HFpEF might be more effective to reduce the global disease burden. To better inform strategies to prevent HFpEF (and HFrEF), detailed insight is needed into disease-specific risk factors. Brouwers and colleagues have now presented exciting new data identifying common and distinct risk profiles for incident HFpEF and HFrEF.4 As part of the community-based Prevention of Renal and Vascular Endstage Disease (PREVEND) study, 8592 subjects living in Groningen, The Netherlands, underwent baseline medical examination along with blood testing and 24 h urine sampling. After a median follow-up duration of 11.5 years, the authors undertook the ambitious enterprise of carefully reviewing all medical records to identify subjects developing incident HF. The HF diagnosis was established …