New Insights into Heart Failure and Amyloidosis in Aging Individuals

Medical News: Researchers from G. D’Annunzio University in Italy and SS. Annunziata Hospital recently published an in-depth study examining Heart Failure with Preserved Ejection Fraction (HFpEF) and its connections with Cardiac Amyloidosis (CA). Both are significant health concerns, especially in older adults. This study aimed to uncover the links between these conditions and understand how they impact heart health in aging individuals. The researchers sought to explain why HFpEF and CA become increasingly prevalent with age and how these conditions interact to affect the heart.


New Insights into Heart Failure and Amyloidosis in Aging Individuals
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This Medical News report explores their findings, focusing on key causes and implications, as well as potential treatment options that may improve patient outcomes.
 
What is Heart Failure with Preserved Ejection Fraction?
HFpEF is a type of heart failure in which the heart’s ability to pump blood remains intact, but it struggles to fill effectively due to stiff heart muscles. This condition predominantly affects older adults, with a notable increase in prevalence after age 65. According to the study, up to 70% of people over 65 are at risk of HFpEF, leading to increased hospitalization rates and significant mortality risks within a few years.
 
The condition results from a mix of age-related changes and risk factors, including hypertension, obesity, diabetes, and oxidative stress. As the heart ages, it undergoes structural changes, such as increased stiffness in the heart muscle cells (cardiomyocytes) and changes in blood pressure regulation. These factors contribute to HFpEF by making it harder for the heart to relax between beats, which is necessary for proper blood flow.
 
The Role of Cardiac Amyloidosis in Heart Health
Another key focus of this study was CA, a condition where protein fragments called amyloids build up between heart cells, causing the heart walls to thicken and stiffen. This buildup impairs the heart’s ability to function normally and often mimics HFpEF symptoms. CA can result from various proteins, but the two most common types are transthyretin amyloidosis (ATTR) and light-chain amyloidosis (AL). ATTR can be hereditary or age-related, while AL involves misfolded immunoglobulin light chains and has a higher toxicity level.
 
The study identified a strong connection between CA and HFpEF, especially in older adults. Many symptoms overlap, making CA difficult to diagnose accurately. Researchers emphasized the need for better screening methods for CA in patients with HFpEF, especially for elderly individuals, as early detection and treatment are essential for improving outcomes.
 
How HFpEF and CA Affect the Aging Heart
As people age, several factors contribute to heart changes that predispose them to HFpEF and CA. The study highlights oxidative stress - a process in which reactive oxygen molecules damage heart cells - and chronic inflammation, both of which increas e with age. This ongoing damage makes the heart stiffer and less elastic, leading to diastolic dysfunction (difficulty relaxing) and elevated filling pressures.
 
The study also noted that in addition to stiffness from amyloid deposits, CA contributes directly to heart cell toxicity. Specifically, AL amyloidosis can disrupt the heart’s redox balance, leading to increased oxidative stress and an imbalance in calcium regulation within heart cells, which harms the heart’s ability to contract and relax. Both CA and HFpEF worsen with age, particularly as the body’s repair mechanisms weaken over time.
 
Treatment and Prevention: Current Strategies and Future Prospects
Currently, treatment for HFpEF and CA is challenging due to their complex, overlapping causes and their prevalence in older, often frail patients. Typical treatments for HFpEF focus on managing symptoms and controlling associated conditions like hypertension, diabetes, and obesity. Diuretics are commonly prescribed to reduce fluid retention, while mineralocorticoid receptor antagonists (MRAs) help address inflammation and fibrosis in heart tissues.
 
In recent years, new drugs have shown promise in treating HFpEF and CA. For instance, sodium-glucose co-transporter 2 (SGLT2) inhibitors, initially developed for diabetes, have shown potential to reduce cardiovascular death and hospitalization rates for HFpEF patients. Additionally, transthyretin stabilizers such as tafamidis have demonstrated effectiveness in reducing hospitalizations and improving survival rates in patients with ATTR-CA.
 
Promising Diagnostic Advances for Early Detection
With early diagnosis being essential for improving patient outcomes, the study emphasizes the importance of advanced imaging techniques and biomarkers for early identification of HFpEF and CA. Tools like cardiac magnetic resonance imaging (CMRI) and nuclear imaging can detect subtle signs of amyloid buildup before they cause severe heart damage. Blood biomarkers, such as NT-proBNP, a marker of cardiac stress, are also being studied for their potential to predict HFpEF and CA earlier in the disease process.
 
Researchers are also exploring genetic screening and non-invasive diagnostic methods, such as laser-microdissection mass spectroscopy and advanced nuclear imaging. Such tools hold the potential to detect disease in its early stages, improving treatment outcomes.
 
Conclusion: A Need for Awareness and Personalized Approaches
This study underscores the need for public awareness and improved screening practices to address HFpEF and CA, especially in elderly populations where these conditions are most common. As the prevalence of these diseases rises with an aging global population, healthcare systems will face increased burdens. Identifying patients at risk, providing accurate diagnoses, and offering personalized treatment options will be crucial for managing these complex conditions.
 
While progress is being made in diagnostics and treatments, challenges remain. The study encourages further research to refine diagnostic tools, develop more effective therapies, and identify new treatment targets for HFpEF and CA. A particular focus should be placed on making treatments accessible and affordable to all, especially in low-resource settings. Policymakers and public health initiatives must work together to ensure that these life-saving treatments reach the people who need them most.
 
Ultimately, this study provides valuable insights into HFpEF and CA, opening the door for future research that could improve the lives of millions affected by these conditions.
 
The study findings were published in the peer-reviewed International Journal of Molecular Sciences.
https://www.mdpi.com/1422-0067/25/21/11519
 
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