And be sure to check out our Adipokine Explorer!

www.jacc.org/jacc/interac...

Here is my substack on the topic: Fat, Reframed.

neverdelegateunderstanding.substack.com/p/fat-reframed

@jaccjournals.bsky.social is the place for ideas that may change our thinking; spark dialogue; and contribute to progress in advancing global cardiovascular health.

HFpEF is one of medicine’s biggest puzzles.

Maybe the answers lie not in the heart alone, but in the cross-talk between fat and myocardium.

Read the full JACC Adipokine Spotlight and join the conversation.

🔗 www.jacc.org/toc/jacc/cur...

#JACC #HFpEF #Cardiology #AdipokineHypothesis

The issue invites disagreement and testing.

Some cases of HFpEF may not fit the model.

But frameworks like this push the field forward—helping us ask sharper questions and design better studies.

Themes emerge:

• It’s about fat distribution, not just BMI.

• Adipokines act through endocrine-paracrine signaling.

• Sex, race, and metabolic context all shape expression and risk.

• New therapies (GLP-1RA, SGLT2i) may restore adipokine balance.

To deepen the discussion, we invited experts across cardiology and metabolism to weigh in:

• Erica Spatz: A Turning Point

• Carolyn Lam & Dalane Kitzman: From Pariah to Paradigm

• Subodh Verma & Deepak Bhatt: Parsing the Adipokine Axis

• Faiez Zannad, Jennifer Ho, Robert Mentz, and others.

As Editor-in-Chief, I wrote about why JACC published it:
Because progress in medicine requires ideas that connect disciplines and challenge assumptions.

🧠 “Ideas Worth Testing: The Adipokine Hypothesis.”

www.jacc.org/doi/10.1016/...

In this 25,000-word State-of-the-Art Review, Packer unites >1,800 references to build a testable framework explaining how dysfunctional adipose tissue could underlie HFpEF.

It’s bold, ambitious—and worth debating.

Dr. Milton Packer proposes that hypertrophied, inflamed fat cells secrete molecules—adipokines—that drive cardiac remodeling, inflammation, and fibrosis.

In other words: HFpEF may begin in fat, not the heart.

The next leap is computable quality.

Living, real-time intelligence from routine clinical data that will:

-Support accountability
-Fuel improvement
-Accelerate discovery

But most current measures fail this test.

Registries = richer than claims but costly, delayed, and not built for improvement

Claims = coarser, even more delayed

Neither delivers what clinicians need at the point of care.

Door-to-balloon time proved what’s possible.

When hospitals had real-time feedback, mortality for STEMI dropped—without new drugs or devices.
The lesson?

👉 Quality improves when data are timely, trusted, and actionable.