HFSA/ASPC Heart Failure Prevention: Heart Failure in Women

A joint statement by the American Society for Preventive Cardiology (ASPC) and the Heart Failure Society of America (HFSA), published on August 13, 2025, shifts the focus of heart failure from recovery to prevention for the first time. “The Continuum of Prevention and Heart Failure in Cardiovascular Medicine” provides clinicians with a framework of strategies to apply across all stages of heart failure, irrespective of ejection fraction.

Instead of viewing the condition as an inevitable outcome, this statement recontextualizes heart failure as a preventable condition. It encourages clinicians to identify and manage risk factors earlier through methods such as glucose management, genetic risk screening, lifestyle interventions, weight loss, and blood pressure control.1

In the sixth episode of a 7-part HCPLive Special Report, moderator James Januzzi, MD, is joined by Martha Gulati, MD, MS, and Anu Lala, MD, to discuss the urgent need to bridge the gap between prevention and heart failure care.

Lala outlines three key priorities for improving prevention in women at risk for heart failure: early identification, closing implementation gaps, and driving policy and payment reform. She stresses that many existing risk tools are based on male populations, which leads to underrecognition of women’s risks. Since women more commonly present with heart failure with preserved ejection fraction (HFpEF) rather than systolic dysfunction, prevention strategies must reflect these differences. She also emphasizes that women often receive less therapy and attention than men, making equitable implementation critical to improving outcomes.

Gulati expands on this, highlighting the importance of sex-specific risk factors in refining risk assessment. Traditional risk calculators, heavily weighted by age, often underestimate the risks faced by young women, such as those experiencing adverse pregnancy outcomes like preeclampsia, gestational diabetes, or hypertension during pregnancy.

These conditions elevate risks for both cardiovascular disease and heart failure within a decade, not just later in life. She also draws attention to peripartum cardiomyopathy and Takotsubo syndrome—forms of heart failure disproportionately affecting women—that are often underdiagnosed and lack effective preventive strategies.

Both experts agree that greater inclusion of women in clinical trials is essential for understanding how therapies apply across sexes. Gulati notes that intentional enrollment efforts have already begun to improve representation in heart failure research, shifting from historically poor female participation toward more balanced studies. This progress, she argues, demonstrates that with deliberate action, clinical trials can better capture sex differences, ultimately informing more effective and equitable care for women at risk of or living with heart failure.

Our Panelists:

• James Januzzi, MD, is the Hutter Family Professor of Medicine at Harvard and the Director of Heart Failure and Biomarker Trials at the Balm Institute for Clinical Research. Januzzi serves as the moderator for this conversation.
• Martha Gulati, MD, MS, is the associate director of the Barbra Streisand Women Heart Center and the director of CVD Prevention at the Smidt Heart Institute at Cedars Sinai Medical Center. She was also the president of the ASPC from 2022-2024.
• Anu Lala, MD, is an associate professor of medicine at the Zena & Michael A Wiener Cardiovascular Institute, and a member of the Department of Population Health Science and Statistics at Icahn School of Mount Sinai and Mount Sinai Hospital.

Editors’ Note: Januzzi reports disclosures with Abbott Laboratories, AbbVie, Inc., Eli Lilly, AstraZeneca Pharmaceuticals, Jana Care, Siemens, and others. Gulati reports disclosures with the American Society of Preventive Cardiology, Eli Lilly, Merck & Co., Boehringer Ingelheim Pharmaceuticals, Medtronic, Zoll, and others. Lala reports disclosures with Abiomed, AstraZeneca, Merck & Co., Novo Nordisk, Sequana, Bayer, and others.

References:

1. Heart Failure Society of America. Heart Failure Society of America and American Society for Preventive Cardiology Joint Statement Calls for a Shift in Heart Failure Prevention and Care. PRNewswire. August 13, 2025. Accessed September 9, 2025. https://www.prnewswire.com/news-releases/heart-failure-society-of-america-and-american-society-for-preventive-cardiology-joint-statement-calls-for-a-shift-in-heart-failure-prevention-and-care-302529062.html

2. Lala A, Beavers C, Blumer V, et al. The continuum of prevention and heart failure in Cardiovascular Medicine: A joint scientific statement from the Heart Failure Society of America and the American Society for Preventive Cardiology. American Journal of Preventive Cardiology. Published online August 13, 2025:101069. doi:10.1016/j.ajpc.2025.101069