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Epigenetic Therapies for Heart Failure: Current Insights and Future Potential
Claudio Napoli1, Paola Bontempo2, Vittorio Palmieri3
1Department of Advanced Medical and Surgical Sciences (DAMSS), University of Campania "Luigi Vanvitelli", Naples, 80138, Italy.
Vascular Health and Risk Management
|June 3, 2021
Summary
Epigenetic therapies, including direct drugs like apabetalone and repurposed drugs such as metformin and SGLT2 inhibitors, show promise for heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF). Further trials will determine their role in personalized HF management.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Epigenetics
Background:
- Heart failure with preserved ejection fraction (HFpEF) lacks standard pharmacological therapies, unlike heart failure with reduced ejection fraction (HFrEF).
- Epigenetic-based therapies (epidrugs) are emerging as a novel approach in cardiovascular disease treatment.
- Several direct and repurposed drugs are being investigated for their epigenetic effects in heart failure.
Purpose of the Study:
- To review recent advancements in epigenetic therapies for both HFpEF and HFrEF.
- To discuss the potential of epidrugs in improving personalized heart failure management.
- To evaluate the efficacy of direct and indirect epigenetic interventions.
Main Methods:
- Review of controlled clinical trials evaluating epigenetic-oriented drugs (e.g., apabetalone) and repurposed drugs (e.g., metformin, statins, SGLT2i, PUFAs).
- Analysis of trial outcomes for both HFrEF and HFpEF patient populations.
- Assessment of drug effects on hospitalization, mortality, and cardiovascular risk.
Main Results:
- Apabetalone showed potential in secondary prevention for patients with type 2 diabetes and acute coronary syndrome.
- Statins, metformin, and SGLT2 inhibitors may benefit HFpEF patients by reducing mortality.
- Metformin and SGLT2 inhibitors showed promise in reducing HF incidence and mortality in HFrEF patients, while statin results were mixed.
- Omega-3 polyunsaturated fatty acids (PUFAs) supplementation was linked to reduced cardiovascular risk in both HFpEF and HFrEF.
Conclusions:
- Epigenetic therapies, both direct and indirect, represent a promising avenue for personalized heart failure treatment.
- Repurposed drugs like metformin and SGLT2 inhibitors demonstrate potential benefits in specific heart failure populations.
- Further large-scale trials are necessary to establish the role of epitherapy in routine clinical practice for HFpEF and HFrEF.
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