Exposomic Determinants in Heart Failure Among Older Adults - Mechanistic Links, Clinical Evidence, and Future Perspectives

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.