The only cardiovascular disease that is still increasing – can exercise help patients with diastolic heart failure?

Anne Marie Ormbostad BerreThere are several large ongoing project in CERG and OptimEx is one of them. OptimEx is a large multicentre project financed by the European Union and researchers, engineers and technicians from several countries and institutions are involved. I am working with OptimEx as a PhD student and therefore I will give the readers of our blog a short version of what OptimEx is all about and why it is invested so much in the project.

As we already know, lifestyle diseases are a huge and increasing burden on the healthcare system. One of the lifestyle diseases that are continuing to grow is heart failure with preserved ejection fraction named HFpEF. HFpEF is one of two types of heart failure affecting more than 7 million Europeans and accounting for 50% of all heart failure cases.

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By iStockphotoThe disease is the only cardiovascular disease that is still increasing and the aging population explains this. What distinguishes the two types of heart failure from each other is which cardiac phase that is most affected. In the more known cases of heart failure, the cardiac muscle is weakened and therefore unable to contract and pump blood needed by the body in order to sustain normal function. However, in patients with HFpEF, the contraction and pumping of blood is to a certain degree sustained. I these patients, the phase when the heart is relaxing and expanding in order to fill with blood before the next contraction, is impaired.

These patients got bad prognosis and 25% of patients’ diagnosed dies within three years. To date, there is no effective treatment and the economic, social and personal burden of HFpEF is therefor large and the disease remains as one of the biggest unmet clinical needs in Europe.

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The poor prognosis is not explained by the patient’s age, gender or the high prevalence of cardiovascular risk factors and further, the underlying mechanisms are poorly understood. Therefore treatment options are sparse; in particular pharmalogical treatments in order to improve outcome and symptoms have been disappointing. Hence, to date there is no pharmalogical treatment effective in improving symptoms and survival in these patients, highlighting the need for new therapeutic strategies to be explored.

Gå tur (Illustrasjonsfoto: Istock)Exercise capacity is a well described predictor of overall mortality both in health and disease and exercise capacity is now accepted as a stronger predictor of survival than other common used variables including smoking, resting heart rate, blood pressure and obesity. In patients with cardiovascular disease, there is a nearly linear correlation between risk reduction of mortality and improved exercise capacity.

Due to the fact that lifestyle dependent risk factors like physical inactivity and physical deconditioning largely contributes to the progressive development of HFpEF, it is believed that exercise training has the potential to outweigh any of the exciting pharmalogical treatments for the syndrome of HFpEF. Therefore, despite a lack of data underpinning it, improving cardiorespiratory fitness is a new treatment strategy that is progressively emerging. Some small studies have reported a 20 % increase in exercise capacity following exercise and in addition a multicentre study reported beneficial effects on cardiac function following exercise training. Based on data from these studies, the goal of OptimEx is to further investigate the effect of different exercise training modes in order to optimize the use of exercise training in the prevention and treatment of HFpEF.

Anne Marie Ormbostad Berre, PhD student at CERG

 

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