Why the study?
This review was conducted to critically reassess HFpEF as a systemic cardio-metabolic disorder.
Reframing HFpEF as a systemic cardio-metabolic syndrome provides a mechanistic rationale for the clinical benefits of SGLT2 inhibitors and GLP-1 receptor agonists over traditional neurohormonal blockade.
Supports metabolic therapies in HFpEF; leaves open prospective RCTs to guide practice.
This review critically reassesses heart failure with preserved ejection fraction (HFpEF) as a systemic cardio-metabolic disorder. Searching PubMed, Scopus, and Web of Science (2000-2025) yielded 108 priority studies, randomized controlled trials (RCTs), prospective cohorts, and mechanistic reports after screening ~800 records. Evidence shows visceral adiposity, insulin resistance, chronic inflammation and mitochondrial dysfunction synergistically impair cardiac energetics. Unlike conventional neuro-hormonal blockade (renin angiotensin aldosterone system or RAAS inhibitors, beta-blockers), which showed neutral outcomes in heterogeneous HFpEF populations, landmark RCTs (EMPagliflozin outcomE tRial in Patients With chrOnic heaRt Failure With Preserved Ejection Fraction (EMPEROR-Preserved), Dapagliflozin Evaluation to Improve the Lives of Patients With Preserved Ejection Fraction Heart Failure (DELIVER)) now demonstrate that sodium-glucose cotransporter-2 inhibitors cut hospitalizations and cardiovascular events, while glucagon-like peptide-1 (GLP-1) receptor agonists improve symptoms, exercise tolerance and weight, validating the metabolic-inflammation paradigm. Persistent phenotypic heterogeneity underscores the need for biomarker-driven phenotyping, advanced imaging and adaptive trial designs to embed metabolic and bioenergetic dimensions into early, precision care.
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Baidya et al. (2026) studied this question.
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