Pharmacology of Heart Failure

A special issue of Pharmaceuticals (ISSN 1424-8247). This special issue belongs to the section "Pharmacology".

Deadline for manuscript submissions: 31 December 2025 | Viewed by 8577

Special Issue Editors


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Guest Editor
1. Department of Pharmacology, Faculty of Medicine, University of Opole, Opole, Poland
2. 2nd Department of Cardiology and Angiology, Silesian Center for Heart Diseases, 41-800 Zabrze, Poland
Interests: heart failure; cardiovascular disease; biomarkers; pharmacological treatment; drug interactions; risk stratification; prognostic scales
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Guest Editor
3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland
Interests: heart failure; heart transplantation; mechanical circulatory support; biomarkers; risk stratification; cardiovascular disease; interventional therapy; device therapy
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Despite advances in the prevention and treatment of cardiovascular diseases, heart failure remains a major challenge in developed countries, and its economic and social burden is still increasing. Over the years, many pharmacological and interventional treatments for heart failure have been developed that have improved the quality of life and global life expectancy. This has contributed to the need for more complex treatment regimens in heart failure, which is further complicated by the increasing age and high levels of comorbidity inherent in this patient group. Furthermore, a number of medications that are commonly used in clinical practice are relatively or absolutely contraindicated in patients with heart failure because they can cause exacerbations to this condition or have significant pharmacodynamic interactions with basic heart failure medications. This requires a holistic assessment of the patient and the meticulous management of medication regimens that are often complex.

Our aim for this Special Issue is to offer our readers short but comprehensive, state-of-the-art articles on the treatment of heart failure with regard to the pharmacokinetics and pharmacodynamics of drugs, drug interactions, adverse effects, and complex treatment regimens for comorbidities in heart failure.

Dr. Wioletta Szczurek-Wasilewicz
Prof. Dr. Bożena Szyguła-Jurkiewicz
Guest Editors

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Keywords

  • heart failure
  • pharmacological treatment
  • drug interactions
  • side effect
  • comorbidities

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Published Papers (3 papers)

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Research

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17 pages, 10468 KB  
Article
IDHP Mitigates LPS-Induced Cardiomyocyte Injury via the GAS6/Axl-AMPK Axis: A Multi-Target Strategy Counteracting Inflammation, Oxidative Stress, and Apoptosis
by Junmin Chen, Yijie Wang, Xingge Li, Xiaoqing Guo, Jiayin Tian, Xiaohui Zheng, Yang Yang and Yanting Cao
Pharmaceuticals 2025, 18(8), 1188; https://doi.org/10.3390/ph18081188 - 12 Aug 2025
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Abstract
Background: Sepsis-induced myocardial injury (SIMI) significantly contributes to sepsis-related mortality, yet effective therapies remain limited. This study investigated the cardioprotective potential of isopropyl 3-(3,4-dihydroxyphenyl)-2-hydroxypropanoate (IDHP), a bioactive metabolite from Salvia miltiorrhiza, focusing on its mechanism via the GAS6/Axl signaling axis in lipopolysaccharide [...] Read more.
Background: Sepsis-induced myocardial injury (SIMI) significantly contributes to sepsis-related mortality, yet effective therapies remain limited. This study investigated the cardioprotective potential of isopropyl 3-(3,4-dihydroxyphenyl)-2-hydroxypropanoate (IDHP), a bioactive metabolite from Salvia miltiorrhiza, focusing on its mechanism via the GAS6/Axl signaling axis in lipopolysaccharide (LPS)-induced myocardial injury. Methods: Using an in vitro HL-1 cardiomyocyte model, IDHP’s cytotoxicity was assessed (0–20 μM). Cells were pretreated with IDHP (10 μM, optimal concentration) before LPS exposure. Inflammatory cytokines (IL-6/TNF-α/IL-1β/IL-18), chemokines (CCL2/CCR2, CCL25/CCR9), ROS levels (Nrf2 pathway), and apoptosis markers (Bax) were quantified. GAS6/Axl-AMPK signaling was evaluated via GAS6 knockout experiments. Results: IDHP (≤20 μM) showed no cytotoxicity. At 10 μM, it exhibited anti-inflammatory effects by reducing LPS-induced cytokine/chemokine release, demonstrated antioxidant activity through lowering ROS via Nrf2 activation, and exerted anti-apoptotic action by downregulating Bax. Mechanistically, IDHP restored GAS6/Axl-AMPK phosphorylation, an effect abolished in GAS6-knockout cells. Conclusions: IDHP mitigates LPS-induced cardiomyocyte injury by concurrently targeting inflammation, oxidative stress, and apoptosis via GAS6/Axl-AMPK signaling, proposing a novel therapeutic avenue for SIMI. Full article
(This article belongs to the Special Issue Pharmacology of Heart Failure)
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Review

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13 pages, 271 KB  
Review
Heart Failure in Elderly Patients: Medical Management, Therapies and Biomarkers
by Paulina Nadziakiewicz, Wioletta Szczurek-Wasilewicz and Bożena Szyguła-Jurkiewicz
Pharmaceuticals 2025, 18(1), 32; https://doi.org/10.3390/ph18010032 - 30 Dec 2024
Cited by 3 | Viewed by 6412
Abstract
Heart failure (HF) is a common condition and one of the main morbidity and mortality factors in elderly patients. The incidence of HF progressively increases with age, reaching >10% in those aged 70 years or over. In the elderly population, both the diagnosis [...] Read more.
Heart failure (HF) is a common condition and one of the main morbidity and mortality factors in elderly patients. The incidence of HF progressively increases with age, reaching >10% in those aged 70 years or over. In the elderly population, both the diagnosis and the management of HF prove challenging, often requiring specialized care and a multidisciplinary approach. In seniors, atypical presentation of HF is much more common than in younger patients; thus, a holistic assessment with biomarkers related to HF allows for early diagnosis and accurate risk stratification in this group of patients. This article reviews the clinical and diagnostic differences in elderly patients with HF, highlighting the presence of comorbidities, frailty, cognitive impairment, and polypharmacy, as well as discussing potential biomarkers that may have clinical application in this population. Full article
(This article belongs to the Special Issue Pharmacology of Heart Failure)

Other

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18 pages, 442 KB  
Systematic Review
Cognitive Safety and Outcomes of Pharmacological Management in Heart Failure: A Systematic Review
by Wiktoria Balcerzak, Gabriela Poczatek, Agnieszka Gorzkowska, Anna Blach, Michal Jurkiewicz and Anetta Lasek-Bal
Pharmaceuticals 2025, 18(11), 1671; https://doi.org/10.3390/ph18111671 - 5 Nov 2025
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Abstract
Background/Objectives: Cognitive impairment (CI) is a common complication of heart failure (HF) that undermines self-care, adherence, and outcomes. This systematic review assessed the cognitive effects of pharmacological HF management and related cardiovascular therapies, identifying potential risks and benefits. Methods: Following PRISMA [...] Read more.
Background/Objectives: Cognitive impairment (CI) is a common complication of heart failure (HF) that undermines self-care, adherence, and outcomes. This systematic review assessed the cognitive effects of pharmacological HF management and related cardiovascular therapies, identifying potential risks and benefits. Methods: Following PRISMA 2020, we searched PubMed, EMBASE, and Scopus for articles published in English between 1 January 2010 and 31 January 2025 (last search 31 January 2025). We included RCTs and cohort studies in adults with HF or high cardiovascular risk that reported cognitive outcomes. Non-pharmacological interventions, studies without relevant cognitive endpoints, and non-original research were excluded. Risk of bias was assessed using RoB 2 for RCTs and the Newcastle–Ottawa Scale for observational studies. Due to heterogeneity in study designs and cognitive measures, results were synthesized qualitatively without meta-analysis. Results: Of 530 records screened, 11 studies encompassing 58,190 participants met the inclusion criteria. Intensive blood pressure (BP) lowering was consistently associated with reduced risk of mild cognitive impairment or dementia compared with standard BP control. In HF populations, sacubitril/valsartan showed no adverse cognitive effects versus other RAAS inhibitors. Across RCTs and observational studies, β-blockers, ACE inhibitors, ARBs, diuretics, and statins showed no evidence of significant cognitive impairment. Comparisons of anticoagulants (dabigatran vs. warfarin; warfarin vs. aspirin) revealed no differences in cognitive trajectories, while optimized medical therapy was associated with parallel improvements in cognitive scores, left ventricular function, and renal parameters. Limitations: Evidence remains constrained by heterogeneity in study design and cognitive assessment tools (often brief screening instruments), inconsistent reporting, and generally short follow-up durations, which may obscure subtle or long-term effects. Conclusions: Contemporary pharmacological therapies for HF appear cognitively safe. Intensive BP control may confer cognitive benefit in high-risk populations, while guideline-directed treatments show no consistent evidence of cognitive harm. Optimized medical therapy may even support cognitive improvement alongside cardiac and renal recovery. Routine cognitive assessment should be integrated into HF care to support individualized management. Full article
(This article belongs to the Special Issue Pharmacology of Heart Failure)
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