The vasculature: a therapeutic target in heart failure?

Cardiovasc Res. 2022 Jan 7;118(1):53-64. doi: 10.1093/cvr/cvab047.


It is well established that the vasculature plays a crucial role in maintaining oxygen and nutrients supply to the heart. Increasing evidence further suggests that the microcirculation has additional roles in supporting a healthy microenvironment. Heart failure is well known to be associated with changes and functional impairment of the microvasculature. The specific ablation of protective signals in endothelial cells in experimental models is sufficient to induce heart failure. Therefore, restoring a healthy endothelium and microcirculation may be a valuable therapeutic strategy to treat heart failure. This review article will summarize the current understanding of the vascular contribution to heart failure with reduced or preserved ejection fraction. Novel therapeutic approaches including next generation pro-angiogenic therapies and non-coding RNA therapeutics, as well as the targeting of metabolites or metabolic signalling, vascular inflammation and senescence will be discussed.

Keywords: Angiogenesis; MicroRNAs; Microcirculation; Non-coding RNAs.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Angiogenesis Inducing Agents / adverse effects
  • Angiogenesis Inducing Agents / therapeutic use*
  • Animals
  • Coronary Circulation / drug effects
  • Coronary Vessels / drug effects*
  • Coronary Vessels / metabolism
  • Coronary Vessels / physiopathology
  • Genetic Therapy* / adverse effects
  • Heart Failure, Diastolic / genetics
  • Heart Failure, Diastolic / metabolism
  • Heart Failure, Diastolic / physiopathology
  • Heart Failure, Diastolic / therapy*
  • Heart Failure, Systolic / genetics
  • Heart Failure, Systolic / metabolism
  • Heart Failure, Systolic / physiopathology
  • Heart Failure, Systolic / therapy*
  • Humans
  • Microcirculation / drug effects
  • Microvessels / drug effects*
  • Microvessels / metabolism
  • Microvessels / physiopathology
  • Neovascularization, Physiologic / drug effects*
  • RNA, Untranslated / genetics
  • RNA, Untranslated / metabolism
  • Recovery of Function
  • Vaccines / adverse effects
  • Vaccines / therapeutic use*
  • Ventricular Function, Left / drug effects


  • Angiogenesis Inducing Agents
  • RNA, Untranslated
  • Vaccines