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In adults with type 2 diabetes and chronic kidney disease enrolled in the FLOW randomized trial, once-weekly subcutaneous semaglutide 1.0 mg versus placebo reduced a composite kidney outcome (≥50% eGFR decline, eGFR <15, dialysis, transplantation, or kidney/cardiovascular death) across subgroups with and without established atherosclerotic cardiovascular disease, heart failure, or high predicted cardiovascular risk (subgroup HRs ~0.67–0.80). Semaglutide also lowered all-cause mortality across these baseline cardiovascular-status subgroups (subgroup HRs ~0.71–0.82), with no significant interactions by cardiovascular status.

This scientific statement reviews contemporary evidence on heart failure (HF) prevention, emphasizing a multidisciplinary, holistic approach that targets arterial hypertension, chronic kidney disease, diabetes, obesity, sedentary lifestyle, dyslipidemia, female-specific risks, oncologic treatment effects, infections/vaccination, and environmental and socioeconomic determinants. It updates the 2022 position paper and 2021 ESC guidelines by highlighting new data—particularly linking metabolic, diabetic, and kidney-disease interventions—to potential reductions in HF incidence and advocates tailored preventive strategies.

An individual patient data meta-analysis of 12 randomized trials including 32,346 HFrEF and 13,723 HFpEF patients examined baseline serum potassium and outcomes. In HFrEF there was a reverse J-shaped relationship with outcomes: potassium <3.5 mmol/L was associated with higher all‑cause mortality (adjusted HR 1.49 versus 4.0–4.5 mmol/L), and the lowest risk for outcomes was observed at baseline potassium around 4.2–5.0 mmol/L; HFpEF showed a flatter U-shaped curve with the same potassium range corresponding to the lowest incidence of outcomes.