Evolutionary Paradigms in Cardiology: The Case of Chronic Heart Failure

Abstract

In this chapter, attempts are made to use an evolutionary perspective for understanding heart failure (HF), a major issue in cardiology and the endpoint of most of cardiovascular diseases (CVDs) including myocardial infarction, arterial hypertension or valve diseases. Evolutionary medicine takes the view that illness is linked to incompatibilities between the environment in which humans currently live and their genome, which has been shaped by several environmental conditions during biological evolution. Chronic HF occurs after a long period of adjustment of the heart to the new working con- ditions imposed by CVD (e.g. atherosclerosis). Such an adjustment has been possible due to an ancient, widespread and evolved cellular response to physical forces, called mechanotransduction. Mechanotransduction renders the maxi- mum cardiac contraction slower and more efficient under increased load. From an evolutionary perspective, the heart fails firstly because the adaptive process reaches its own limits. In addition, the anthropogenic increase in lifespan and the accompanying ageing have contributed a new dimension, cardiac fibrosis, that aggravates cardiac function and is one of main biological marker for HF.