Despite the progress made during the last decades in the prevention and treatment of cardiovascular diseases, heart failure is still associated with a high risk of hospitalization, especially in elderly patients (>65 years), and 1-year mortality can reach 20-25% with considerable costs for national health systems.

In recent years the prevalence of heart failure with preserved ejection fraction (HFpEF) has been progressively increasing (now approximately 50% of HF), and this is due to several factors, among which the aging of the population and the increase in the incidence of conditions such as arterial hypertension, diabetes and obesity are certainly relevant. While these factors are recognized, there remains a necessity to explore beyond them. In fact, it has been known for many years and with considerable support from scientific literature that insulin resistance with associated hyperinsulinemia determines over the years, if neglected, type 2 diabetes and cardiovascular diseases, including hypertension, atherosclerosis and heart disease with concentric remodeling of the left ventricle, and this to remain only in the cardiovascular field. It is also known that the prevalence of insulin resistance in the general population is progressively increasing in developed and developing countries. Furthermore, the prevalence of insulin resistance is very high in subjects with HF, particularly in those with HFpEF. Insulin resistance is a condition in which certain amounts of insulin result in insufficient control of glucose metabolism compared to that expected, so that the pancreas, in order to maintain glucose levels in the normal range, is forced, as much as it can, to chronically secrete greater amounts of insulin. For this reason, hyperinsulinemia is a constant feature of insulin resistance.

It is very likely that there is a close causal relationship between insulin resistance/hyperinsulinemia and development or worsening of HFpEF.

This Research Topic aims to decode the intricate relationship between insulin resistance, hyperinsulinemia, and HFpEF. We aim to deepen the understanding of the mechanisms connecting insulin resistance to the pathophysiology of HFpEF. Moreover, the research intends to identify therapeutic and preventive strategies to mitigate this interrelation. Our goal encompasses exploring causal pathways and plausible interventions, potentially unveiling novel treatments and preventive approaches for HFpEF.

To gather further insights into these interactions and potential implications, we welcome articles addressing, but not limited to, the following themes:
o Mechanisms linking insulin resistance and HFpEF.
o Epidemiological studies on insulin resistance in heart failure patients.
o Clinical trials focusing on interventions targeting insulin resistance in HFpEF.
o Assessing the role of hyperinsulinemia in the progression of HFpEF.
o Novel therapeutics aimed at reducing insulin resistance in the context of heart failure.

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Decoding Insulin Resistance in Heart Failure with Preserved Ejection Fraction