From Risk to Biology

Preventing heart failure (HF) demands a shift in how we conceptualize risk. Current strategies focus almost exclusively on high-risk individuals, defined by short-term risk thresholds, where instantaneous yields on preventive therapy are most visible. However, this approach overlooks the far larger group of patients who accrue risk gradually across decades. True impact on both health care expenditure and population longevity will come from reframing HF prevention as a lifelong trajectory, not a 10-year calculation.

Early identification of subclinical disease or heightened susceptibility earlier in age offers an opportunity to bend the curve of HF incidence, compress morbidity, and extend healthy life span. Although high-risk targeting yields short-term return on investment, lower- and intermediate-risk groups represent a long-horizon strategy, one that can compound benefits across generations. It is in this context that the current ARIC (Atherosclerosis Risk In Communities) analysis of PREVENT-HF (Predicting Risk of Cardiovascular Events-Heart Failure) risk and preclinical HF by Grant et al, ¹ published in this issue of JACC: Heart Failure, provides critical insight.