By AMERICAN HEART ASSOCIATION NEWS

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Editor’s note: This is one in a series of Cardiovascular Genome-Phenome Study Discovery grants to speed personalized treatments and prevention for heart disease.

Advanced heart failure can be as lethal as cancer, according to a researcher who said aggressively finding ways to prevent and treat heart failure is critical.

“Many people don’t know that heart failure has a poor prognosis,” said Sanjiv Shah, M.D., associate professor of medicine and director of the heart failure with preserved ejection fraction program at Northwestern University. “Once hospitalized for heart failure, survival is similar to that of many advanced cancers, meaning that these patients are at a very high risk of dying if their heart failure is not treated and managed appropriately.”

Shah is conducting research funded by the American Heart Association. Last November, Shah was among 10 researchers each awarded about $160,000 to study ways to individualize the treatment and prevention of heart disease. The new Discovery grants are funded by AstraZeneca and probe three areas: heart failure, the “good” HDL cholesterol and predicting cardiovascular disease.

There are two major types of heart failure: heart failure with reduced ejection fraction and heart failure with preserved ejection fraction. In patients with reduced ejection fraction, the heart doesn’t squeeze well. Thanks to research, it is well understood how to diagnose and treat this type of heart failure.

In heart failure with preserved ejection fraction, the heart squeezes normally but the heart muscle doesn’t relax like it should when filling with blood. These patients – often women and older people – are tough to treat and there are lots of unknowns, Shah said.

High blood pressure is a major risk factor, but it remains a mystery why some people with high blood pressure develop heart failure while others do not. Shah and his research team will use innovative methods to find out. “We’ll be using cutting-edge techniques to measure proteins and genetic data (DNA and RNA) in patients to unravel the mystery of why some people with high blood pressure develop heart failure with preserved ejection fraction while others do not,” Shah said.

Shah is working with collaborators at the Medical College of Wisconsin. Using blood samples from people with high blood pressure, the Wisconsin researchers transformed the genes from blood cells into heart muscle cells. Studying those cells can provide insight into the development of heart failure – and it all starts with a simple blood draw.

“We hope our study allows us to predict which patients with high blood pressure will develop heart failure, and figure out new ways to treat and prevent heart failure,” Shah said.

To understand heart failure with preserved ejection fraction, Shah said, think of the heart like a spring. “When a spring is really stiff, it’s hard to pull apart – similar to what happens in heart failure with preserved ejection fraction,” he said. “The heart is too stiff, so it’s hard to expand. Blood can’t get in the heart, so not enough gets out.”

Instead, blood backs up into the lungs and body and causes shortness of breath, fatigue and leg swelling. The stiff heart in these patients, combined with abnormalities in other organs, can interfere with everyday activities and puts them at high risk for hospitalization, Shah said.

Heart failure affects about 5.7 million U.S. adults and is the leading cause of hospitalization for older people. The condition can develop when other heart diseases or risk factors for heart disease are not well controlled, Shah said.

Read about the other stories in this series.