Risk factors for the development of heart failure in patients with or without prior myocardial infarction

Abstract

This article refers to 'Comparing and contrasting risk factors for heart failure in patients with and without history of myocardial infarction: data from HOMAGE and the UK Biobank' by T. Rastogi et al., published in this issue on pages 976-984.One in five men and women will develop heart failure (HF) during their lifetime. 1 Once patients have developed HF, their mortality and morbidity are high. 2 Identifying those patients at risk for the development of HF is therefore important. In particular, modifiable risk factors -like hypertension, hypercholesterolaemia, obesity, smoking and diabetes mellitus -have the potential to prevent HF and are cost-effective public health interventions. 3,4 Cardiac ischaemia, through either a previous myocardial infarction (MI) or coronary artery disease (CAD), is among the chief risk factors for developing HF. 5,6 From studies in patients with prevalent HF we learned that patients with ischaemia and HF have unique characteristics: they are more often men, rather have HF with reduced ejection fraction (HFrEF) than HF with preserved ejection fraction (HFpEF), and have more comorbidities. 7 Importantly, network analysis of proteins highlighted activation of unique pathophysiological pathways in patients with ischaemia, relating to inflammation, endothelial dysfunction, coagulation and atherosclerosis. 8 Whether cardiac ischaemia influences the association of risk factors for incident HF is important to design effective prevention strategies.Against this background, in this issue of the Journal, the study by Rastogi et al. 9 provides new insights into the modifying effects of MI on risk factors for HF. The authors used data from 26 478 participants of the Heart 'OMics' in AGEing (HOMAGE) database to investigate whether a previous history of MI modified the association between risk factors and incident HF hospitalization. Their results were validated in 500 001 participants from the UK The opinions expressed in this article are not necessarily those of the Editors of the European Journal of Heart Failure or of the European Society of Cardiology.