Epidemiology and pathophysiology of heart failure with a preserved ejection fraction
Epidemiology and pathophysiology of heart failure with a preserved ejection fraction
This thesis of Bart van Essen investigates how heart failure with preserved ejection fraction (HFpEF) develops, which risk factors are involved, how common it is, and which biological mechanisms underlie the disease. HFpEF is common, particularly among older patients and women, and is often accompanied by conditions such as high blood pressure, obesity, and diabetes.
Findings from the Groningen PREVEND study showed that about one in four men and one in five women will develop heart failure during their lifetime. Women were more likely to develop HFpEF, whereas men more often developed heart failure with reduced ejection fraction (HFrEF). The same study also demonstrated that eight well-known, modifiable risk factors – including hypertension, obesity, and high cholesterol – account for the majority of new heart failure cases. These results indicate that prevention and better treatment of these risk factors have the potential to substantially reduce the number of new heart failure patients.
In addition to these epidemiological insights, biological mechanisms were also investigated. Using advanced -omics techniques, thousands of genes and proteins in blood samples were analyzed. The analyses revealed that processes related to inflammation and immune activation play a central role in HFpEF, such as the formation of neutrophil extracellular traps (NETs) and elevated levels of inflammatory proteins like Serum Amyloid A1 (SAA1).
The results show that HFpEF is not a single disease, but a syndrome with multiple causes and mechanisms. An integrated approach combining population studies and molecular analyses is essential to move towards a more refined classification and more personalized treatments.