A study of 12 cardiac biomarkers in four cohorts comprising 22,756 participants found that different biomarkers predict incident heart failure with preserved ejection fraction (HFpEF) versus heart failure with reduced ejection fraction (HFrEF) (JAMA Cardiol 2018; doi:10.1001/jamacardio.2017.4987). The findings highlight the need for future studies to better understand the role of biomarkers in estimating risk for these two types of heart failure (HF), according to the authors. Overall, the biomarkers only modestly improved HFpEF risk prediction, which underscores the limitations in understanding factors that lead to this form of HF.

The 12 biomarkers examined included: N-terminal pro B-type natriuretic peptide (or brain natriuretic peptide); troponin (cTn); C-reactive protein (CRP); urinary albumin to creatinine ratio (UACR); renin to aldosterone ratio; D-dimer; fibrinogen; soluble suppressor of tumorigenicity; galectin-3; cystatin C; plasminogen activator inhibitor 1; and interleukin 6.

During a median 12 years’ follow-up, two biomarkers were significantly associated with incident HFpEF, UACR, and natriuretic peptides, with suggestive, but not statistically significant associations, for cTn, plasminogen activator inhibitor 1, and fibrinogen. In contrast, six biomarkers reflecting renal dysfunction, endothelial dysfunction, and inflammation were associated with incident HFrEF, including natriuretic peptides, UACR, cTn, cystatin C, D-dimer,
and CRP.

With HF already a major public health burden and expected to become only more prevalent, methods to prevent and assess risk for HF have taken on more urgency, according to the authors.