Exposomic Determinants in Heart Failure Among Older Adults - Mechanistic Links, Clinical Evidence, and Future Perspectives.
8 affiliations
- 1Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
- 2German Center for Cardiovascular Research (DZHK), Partner Site Rhine- Main, Mainz, Germany.
- 3CSIR-Institute of Minerals and Materials Technology, Bhubaneswar, India.
- 4All India Institute of Medical Sciences, Bhubaneswar, India.
- 5National Institute of Technology, Rourkela, India.
- 6Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
- 7Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany. [email protected].
- 8German Center for Cardiovascular Research (DZHK), Partner Site Rhine- Main, Mainz, Germany. [email protected].
Abstract
Purpose of review
Heart failure (HF) in older adults emerges from the interplay between biological aging and the totality of environmental and behavioural exposures conceptualized as the exposome. Traditional cardiovascular risk factors and intrinsic cardiac pathology only partially explain HF burden, as chronic exposures to air pollution, traffic noise, temperature extremes, toxic metals and chemicals, artificial light at night, and adverse social environments, along with low greenness and walkability, substantially influence HF incidence, decompensations, and prognosis in older patients with multiple comorbidities.Recent findings
Recently, epidemiological studies have associated many of the exposomic factors with HF incidence and morbidity. Age‑related impairments of the myocardium and vasculature make them particularly vulnerable to external stressors. Mechanistically, aging, HF, and environmental factors converge on shared pathways including, oxidative stress and mitochondrial dysfunction, inflammaging, impaired autophagy and proteostasis, genomic and epigenetic alterations, cellular senescence, dysregulated neurohormonal and circadian signalling, and fibrosis with maladaptive remodelling. Through these mechanisms exposome chronically accelerates cardiovascular aging and lowers the threshold for HF onset and progression. This review considers a shift from an organ‑centred view of HF in older adults to a systems‑level, life‑course perspective that explicitly incorporates exposomic determinants, and argues that reducing harmful exposures while promoting green space, physical activity, walkability, and healthy dietary patterns should be integral to HF prevention and management strategies in aging societies.
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BibTeX
@article{hahad2026exposomic,
title = {{Exposomic Determinants in Heart Failure Among Older Adults - Mechanistic Links, Clinical Evidence, and Future Perspectives.}},
author = {Omar Hahad and Thomas Münzel and Jiayin Zheng and Arijan Valar and Yanislav Hrytseniuk and Boopathy Ramasamy and Amit Ghosh and Monalisa Mishra and Trupti Das and Philipp Lurz and Andreas Daiber and Marin Kuntic},
journal = {Current heart failure reports},
year = {2026},
month = oct,
doi = {10.1007/s11897-026-00781-w},
url = {https://europepmc.org/article/MED/42925369},
note = {CC BY},
}
RIS
TY - JOUR
TI - Exposomic Determinants in Heart Failure Among Older Adults - Mechanistic Links, Clinical Evidence, and Future Perspectives.
AU - Omar Hahad
AU - Thomas Münzel
AU - Jiayin Zheng
AU - Arijan Valar
AU - Yanislav Hrytseniuk
AU - Boopathy Ramasamy
AU - Amit Ghosh
AU - Monalisa Mishra
AU - Trupti Das
AU - Philipp Lurz
AU - Andreas Daiber
AU - Marin Kuntic
PY - 2026
DA - 2026/10/24
JO - Current heart failure reports
DO - 10.1007/s11897-026-00781-w
UR - https://europepmc.org/article/MED/42925369
AB - Purpose of review Heart failure (HF) in older adults emerges from the interplay between biological aging and the totality of environmental and behavioural exposures conceptualized as the exposome. Traditional cardiovascular risk factors and intrinsic cardiac pathology only partially explain HF burden, as chronic exposures to air pollution, traffic noise, temperature extremes, toxic metals and chemicals, artificial light at night, and adverse social environments, along with low greenness and walkability, substantially influence HF incidence, decompensations, and prognosis in older patients with multiple comorbidities.Recent findings Recently, epidemiological studies have associated many of the exposomic factors with HF incidence and morbidity. Age‑related impairments of the myocardium and vasculature make them particularly vulnerable to external stressors. Mechanistically, aging, HF, and environmental factors converge on shared pathways including, oxidative stress and mitochondrial dysfunction, inflammaging, impaired autophagy and proteostasis, genomic and epigenetic alterations, cellular senescence, dysregulated neurohormonal and circadian signalling, and fibrosis with maladaptive remodelling. Through these mechanisms exposome chronically accelerates cardiovascular aging and lowers the threshold for HF onset and progression. This review considers a shift from an organ‑centred view of HF in older adults to a systems‑level, life‑course perspective that explicitly incorporates exposomic determinants, and argues that reducing harmful exposures while promoting green space, physical activity, walkability, and healthy dietary patterns should be integral to HF prevention and management strategies in aging societies.
SN - 1546-9530
SN - 1546-9549
ER -