Reply to: Heart Failure With Preserved Ejection Fraction in Older Adults

TY - JOUR

T1 - Reply to

T2 - Heart Failure With Preserved Ejection Fraction in Older Adults

AU - Matsushita, Kenichi

AU - Harada, Kazumasa

AU - Miyazaki, Tetsuro

AU - Miyamoto, Takamichi

AU - Kohsaka, Shun

AU - Iida, Kiyoshi

AU - Yamamoto, Yoshiya

AU - Nagatomo, Yuji

AU - Yoshino, Hideaki

AU - Yamamoto, Takeshi

AU - Nagao, Ken

AU - Takayama, Morimasa

N1 - Funding Information: Kenichi Matsushita MD kenichi-matsushita@umin.ac.jp Kazumasa Harada MD Tetsuro Miyazaki MD Takamichi Miyamoto MD Shun Kohsaka MD Kiyoshi Iida MD Yoshiya Yamamoto MD Yuji Nagatomo MD Hideaki Yoshino MD Takeshi Yamamoto MD Ken Nagao MD Morimasa Takayama MD Tokyo CCU Network Scientific Committee Tokyo Japan Division of Cardiology, Second Department of Internal Medicine Kyorin University School of Medicine Tokyo Japan Tokyo Metropolitan Government N/A Vehicle Racing Commemorative Foundation 5991 Japan Society for the Promotion of Science KAKENHI 17K09523 This letter comments on the letter by Asit Shil . This letter comments on the letter by Asit Shil To the Editor: Although we did not examine the effects of therapies in the present study, we agree that investigation of the effects of therapeutic agents, such as angiotensin‐converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), mineralocorticoid receptor antagonists, and estrogen replacement therapy, on heart failure with preserved ejection fraction (HFpEF) is important. Recent meta‐analyses of randomized controlled trials (RCTs) did not show significant benefits of renin‐angiotensin system inhibitors (ACEIs or ARBs) on mortality of patients with HFpEF. To date, no agent has been found to reduce mortality among patients with HFpEF. However, HFpEF is a highly heterogeneous condition, and our study demonstrated significant differences in the clinical characteristics between HFpEF patients aged 65 to 84 years and those aged 85 years and older. The negative results of RCTs examining therapeutic agents for HFpEF may be owing to such heterogeneity, and thus, specific HFpEF phenotypes that would benefit from certain treatments could be identified based on the phenotypic diversity of HFpEF. Further well‐organized RCTs are warranted to provide vital evidence for treating patients with HFpEF. We thank Shil et al for their interest and comments on our study, “Younger‐ vs Older‐Old Patients with Heart Failure with Preserved Ejection Fraction.” Although we did not directly measure frailty in the present study, we analyzed body mass index (BMI) and reported that HFpEF patients aged 85 years and older had significantly lower BMI than those aged 65 to 84 years (median [interquartile range] = 20.6 [18.3‐23.2] vs 22.3 [19.6‐25.0] kg/m Shil et al also raised an important point regarding the relationship between HFpEF and frailty in the older‐old patients. 2 , respectively; Therefore, we presume that our results are consistent with the comment by Shil et al In this regard, the pathogenesis of HFpEF implies a systemic proinflammatory state as the origin of microvascular endothelial cell inflammation and subsequent cardiac remodeling and dysfunction, suggesting an association between frailty and HFpEF among the older patients. Indeed, the effect of frailty on mortality is high among older patients with heart failure. As suggested by Shil et al, developing therapies for frailty is an important area of research, and systemic inflammation could be one of the therapeutic targets. P  < .001). 1 that frailty increases with age. Importantly, inflammation contributes significantly to frailty, and the association between aging and systemic proinflammatory states has been suggested. In conclusion, the ultimate question is whether agents with therapeutic effects on HFpEF among the older patients can be found. We agree with Shil et al 1 that further research is warranted to address this important aspect. Funding Information: The authors thank Ms Nobuko Yoshida (Tokyo CCU Network office) for her support with data collection. The Tokyo CCU Network data registry is financially supported by the Tokyo Metropolitan Government. Kenichi Matsushita was supported by research grants from the Japan Society for the Promotion of Science (KAKENHI 17K09523) and the Vehicle Racing Commemorative Foundation (No. 5991). Morimasa Takayama reports receiving lecture fees from Daiichi Sankyo Pharmaceutical Co Ltd, outside the submitted work. All other authors declare that they have no conflicts of interest to disclose. K. Matsushita: drafted the letter response and approved the version to be published. K. Harada, T. Miyazaki, T. Miyamoto, S. Kohsaka, K. Iida, Y. Yamamoto, Y. Nagatomo, H. Yoshino, T. Yamamoto, K. Nagao, and M. Takayama: revised the letter response for important intellectual content and approved the final version to be published. The funders had no role in the execution of this study or the interpretation of the results. Funding Information: The Tokyo CCU Network data registry is financially supported by the Tokyo Metropolitan Government. Kenichi Matsushita was supported by research grants from the Japan Society for the Promotion of Science (KAKENHI 17K09523) and the Vehicle Racing Commemorative Foundation (No. 5991).

PY - 2020/3/1

Y1 - 2020/3/1

UR - http://www.scopus.com/inward/record.url?scp=85076797590&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85076797590&partnerID=8YFLogxK

U2 - 10.1111/jgs.16301

DO - 10.1111/jgs.16301

M3 - Letter

C2 - 31859370

AN - SCOPUS:85076797590

SN - 0002-8614

VL - 68

SP - 665

EP - 666

JO - Journal of the American Geriatrics Society

JF - Journal of the American Geriatrics Society

IS - 3

ER -