Pathogenesis of chronic heart failure: cardiovascular aging, risk factors, comorbidities, and disease modifiers

Chronic heart failure (HF) is rare in the young and common in the elderly in the Western world. HF in the young is usually due to specific causes, predominantly or exclusively affecting the heart (adult congenital heart disease, different types of cardiomyopathies, myocarditis, or cardiotoxicity). I...

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Bibliographic Details
Published in:Heart failure reviews Vol. 27; no. 1; pp. 337 - 344
Main Authors: Triposkiadis, Filippos, Xanthopoulos, Andrew, Parissis, John, Butler, Javed, Farmakis, Dimitrios
Format: Journal Article
Language:English
Published: New York Springer US 01.01.2022
Springer Nature B.V
Subjects:
Adult
Aged
Aging
Cardiology
Cardiotoxicity
Cardiovascular disease
Cardiovascular diseases
Congestive heart failure
Coronary artery
Coronary artery disease
Diabetes mellitus (non-insulin dependent)
Diabetes Mellitus, Type 2
Fibrillation
Geriatrics
Heart Defects, Congenital
Heart failure
Heart Failure - epidemiology
Heart Failure - etiology
Humans
Hypertension
Kidney diseases
Lung diseases
Medicine
Medicine & Public Health
Metformin
Myocardial infarction
Myocarditis
Na+/glucose cotransporter
Obesity
Patients
Phenotypes
Risk Factors
Sodium-Glucose Transporter 2 Inhibitors
Stroke Volume
Ventricle
Ventricular Function, Left
Heart failure
Disease modifiers
Comorbidities
Cardiovascular aging
Risk factors
ISSN:1382-4147, 1573-7322, 1573-7322
Online Access:Get full text
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Summary:Chronic heart failure (HF) is rare in the young and common in the elderly in the Western world. HF in the young is usually due to specific causes, predominantly or exclusively affecting the heart (adult congenital heart disease, different types of cardiomyopathies, myocarditis, or cardiotoxicity). In contrast, the mechanisms underlying HF development in the elderly have not been completely delineated. We propose that in most elderly patients, HF, regardless of the left ventricular ejection fraction (LVEF), is the consequence of the acceleration of cardiovascular aging by specific risk factors (usually hypertension, obesity, type 2 diabetes mellitus [T2DM], coronary artery disease [CAD], and valvular heart disease [VHD]), most affecting both the heart and the vasculature. These risk factors act individually or more commonly in groups, directly or indirectly (hypertension, obesity, and T2DM may lead to HF through an intervening myocardial infarction). The eventual HF phenotype and outcomes in the elderly are additionally dependent on the presence and/or development of comorbidities (atrial fibrillation, anemia, depression, kidney disease, pulmonary disease, sleep disordered breathing, other) and disease modifiers (race, sex, genes, other). The clinical implications of this paradigm are that aggressive treatment of hypertension, obesity, T2DM (preferably with metformin and sodium-glucose cotransporter-2 inhibitors), CAD, and VHD on top of measures that retard cardiovascular aging are the steadfast underpinning for HF prevention in the elderly, which represent the vast majority of HF patients.
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ISSN:1382-4147
1573-7322
1573-7322
DOI:10.1007/s10741-020-09987-z