The Diabetic HFpEF Phenotype: Is it Real and is it Worth Targeting Therapeutically?
For investigators, physicians, and patients, the inability to identify therapies to improve clinical outcomes, particularly mortality, in patients with heart failure with preserved ejection fraction (HFpEF) has been particularly vexing and stands in stark contrast to the progress made in the treatment of patients with heart failure with reduced ejection fraction (HFrEF). This has prompted a return to the proverbial drawing board, forcing a reconsideration of long-held assumptions and paradigms. Despite different underlying etiologies, patients with HFrEF are generally responsive to several classes of medications that target the neurohormonal axis. Conversely, the lack of benefit of these therapies in patients with HFpEF has prompted a re-evaluation of whether HFpEF is one disease or many. Is there a unifying pathophysiology of HFpEF or is it better characterized as an amalgamation of distinct, albeit overlapping, phenotypes?
- Received November 11, 2016.
- Revision received November 22, 2016.
- Accepted November 29, 2016.