Title:Treating Heart Failure with Preserved Ejection Fraction Related to Arterial Stiffness. Can we Kill Two Birds With One Stone?
Volume: 13
Issue: 3
Author(s): Vasilios G. Athyros, Efstathios D. Pagourelias, Thomas D. Gossios and Vasilios G. Vasilikos
Affiliation:
Keywords:
Heart failure, preserved ejection fraction, arterial stiffness, arterial hypertension, statins, diabetes mellitus, aneamia,
chronic kidney disease.
Abstract: Heart failure with preserved ejection fraction (HFpEF). Arterial hypertension (AH), arterial
stiffness (AS), older age, and female gender are the main determinants of HFpEF, but several cardiac
or extra-cardiac pathologies are also possible causes. The combined ventricular-vascular stiffening
(abnormal left atrium-left ventricle coupling related to AS) is the main contributor of the increased
prevalence of HFpEF in elderly persons, particularly elderly women, and in younger persons with AH. The hospitalization
and mortality rates of HFpEF are similar to those of heart failure with reduced EF (HFrEF). However, although the prognosis
of HFrEF has been substantially improved during the last 2 decades, the effective treatment of HFpEF remains an
unmet need. Regimens effective in HFrEF have no substantial effect on HFpEF, because of different pathophysiologies of
the 2 syndromes. Pipeline drugs seem promising, but it will take some years before they are commercially available. Aggressive
treatment of noncardiac comorbidities seems to be the only option at hand. Treatment of anaemia, sleep disorders,
chronic kidney disease (CKD), non-alcoholic fatty liver (NAFLD), atrial fibrillation, diabetes, and careful use of diuretics
to reduce preload are effective to some degree. Statin treatment, despite the presence of dyslipidaemia, deserves
special attention because it has been proven, mainly in small studies or post hoc analyses of trials, that it offers a substantial
improvement in quality of life and a reduction in mortality rates. We need to urgently utilize these recourses to relieve
a considerable part of the general population suffering from HFpEF, a deadly disease.
