The U.S. heart failure landscape is transforming—and fast. 🫀📊   A new JACC analysis reveals a 35-year shift from ischemic to metabolic drivers of heart failure, with obesity, dysglycemia, and chronic kidney disease rising sharply, even as blood pressure, cholesterol, smoking, and myocardial infarction decline. 📉⚖️   These trends demand a new generation of HF trials—more inclusive, prevention-focused, metabolism-centered, and designed to capture outcomes beyond cardiovascular death. 🚀🧬   A powerful reminder: heart failure is not inevitable—but the way we study and prevent it must evolve. 🌅💡

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