Little is known about outcomes of patients with heart failure (HF) with preserved ejection fraction (HFpEF) who previously had reduced ejection fraction (HFrEF). Kalogeropoulos and coworkers studied 350 patients with previous HFrEF in whom ejection fraction recovered with time (HFrecEF), 466 with HFpEF (with no previous documentation of HFrEF), and 1350 with HFrEF. Over 3 years, patients with HFrecEF had significantly lower rates of mortality and cardiovascular hospitalizations than patients with HFrEF or HFpEF, suggesting that HFpEF is a heterogeneous condition comprising those who have never had HFrEF and those who have recovered from HFrEF. An accompanying Editorial by Wilcox and Yancy emphasizes the need for more research in this third subset of patients with HF, including mechanisms for recovery and the need to develop therapies to enhance recovery in those with this potential for improvement.
High-sensitivity cardiac troponin T (hs-cTnT) is a biomarker of cardiovascular risk, but data linking long-term changes in hs-cTnT and cardiac events are lacking. McEvoy and coworkers prospectively assessed serial changes in hs-cTnT over 6 years in 8838 participants in the Atherosclerosis Risk in Communities (ARIC) Study who were initially free of coronary heart disease (CHD) or heart failure (HF). At all levels of baseline hs-cTnT, increases in hs-cTnT with time were associated with subsequent CHD, HF (both reduced and preserved ejection fraction), and death. In an accompanying Invited Commentary, Januzzi notes that further studies are needed to determine whether preventive strategies can reduce risk in those with elevated hs-cTnT and whether additional biomarkers (such as pro鈥揃-type natriuretic peptide) in combination with hs-cTnT can further refine risk prediction.
Whether sustained physical activity prevents cardiovascular disease (CVD) events in older adults is uncertain. Newman and coworkers evaluated CVD events in 1635 initially sedentary participants in the prospective multicenter Lifestyle Interventions and Independence for Elders (LIFE) study who were randomized to a structured moderate-intensity exercise program or to a weekly health education session. Previous report of the primary results showed that the exercise intervention reduced mobility disability. However, during the mean 2.6-year follow-up period, the exercise intervention was not associated with reduced rates of the composite CVD end point or death, myocardial infarction, stroke, or heart failure.
The cardiovascular (CV) death rate declined significantly in the United States during the latter half of the 20th century. Sidney and coworkers interrogated the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research data system to determine national trends in age-adjusted CV and cancer mortality rates from 2000 to 2014. There was a substantial deceleration in the decline in CV mortality after 2011, whereas the rate of decline for cancer mortality remained relatively stable. An Invited Commentary by Lloyd-Jones emphasizes that the deflection point in 2011 in CV mortality creates a societal imperative to redouble prevention efforts on all fronts.